Individual
PROF. KEITH M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
222 PIEDMONT AVE, CINCINNATI, OH 45219-4231
(513) 475-8400
(513) 475-8228
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 585-5507
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
35062146
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528009768
RAILROAD MEDICARE
OH
Enumeration date
06/09/2006
Last updated
12/12/2017
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