Individual
DR. RICHARD A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
15300 WEST AVE, SUITE 20, ORLAND PARK, IL 60462-4600
(708) 460-5550
(708) 226-2595
Mailing address
12251 S 80TH AVE, SUITE 1630, PALOS HEIGHTS, IL 60463-1256
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036065125
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065125
—
IL
01
—
F400265424
MEDICARE PTAN
IL
Enumeration date
08/04/2005
Last updated
01/24/2017
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