Individual
DR. PETER J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2142 N COVE BLVD, TOLEDO, OH 43606-3895
(419) 471-4491
(419) 479-6905
Mailing address
2914 S REPUBLIC BLVD, TOLEDO, OH 43615-1912
(419) 531-8808
(419) 531-9342
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35049169
OH
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
350149169
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050064648
RAILROAD MEDICARE
OH
01
—
0611752
BCMH
OH
05
—
0611752
—
OH
01
—
104071557
MICHIGAN MEDICAID
MI
01
—
341877986015
MMO
OH
Enumeration date
07/12/2005
Last updated
03/08/2012
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