Individual
BENJAMIN MICHAEL WILDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MAT, ATC
Contact information
Practice address
31 SUNNEN DR APT 345, MAPLEWOOD, MO 63143-3828
(847) 902-8604
Mailing address
31 SUNNEN DR APT 345, MAPLEWOOD, MO 63143-3828
(847) 902-8604
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2018024534
MO
Other
Enumeration date
02/26/2018
Last updated
11/02/2018
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