Individual
KURTIS WAYNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
440 W SONGER LN, VEEDERSBURG, IN 47987-8547
(765) 762-4180
Mailing address
440 W SONGER LN, VEEDERSBURG, IN 47987-8547
(765) 762-4180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02008204A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3810-03-0390
DRIVER'S LICENSE
IN
Enumeration date
06/23/2021
Last updated
01/24/2025
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