Individual
DR. MICHAEL S WILSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
234 GOODMAN ST, CINCINNATI, OH 45219-2364
(513) 584-8577
(513) 584-5618
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 245-3107
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35 088361
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224457
UNISON
OH
01
—
000000533008
ANTHEM
OH
05
—
2683850
—
OH
01
—
364139
WELLCARE MEDICAID
OH
01
—
7339878
AETNA
OH
Enumeration date
07/15/2006
Last updated
02/08/2018
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