Individual
BRADLEY A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 N 8TH ST, SPRINGFIELD, IL 62701-1041
(217) 544-6464
Mailing address
301 N 8TH ST, SPRINGFIELD, IL 62701-1041
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036118588
IL
208600000X
Surgery Physician
2005016227
MO
208600000X
Surgery Physician
Primary
36118588
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207215500
—
MO
01
—
207988
MEDICARE GRP NUMBER
IL
01
—
208959
MEDICARE GRP NUMBER
IL
01
—
718653
HEALTHLINK
MO
01
—
7470693
AETNA
MO
01
—
CE9335
RR GROUP
IL
01
—
I37919
MERCY HEALTH PLANS
MO
01
—
P00396925
RR MEDICARE NUMBER
IL
Enumeration date
01/04/2006
Last updated
05/29/2026
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