Individual
JOHN MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
(616) 252-7429
(616) 252-6297
Mailing address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
(616) 252-7429
(616) 252-6297
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
4301061808
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538124508
—
MI
05
—
3440997
—
MI
01
—
4301061808
MICHIGAN STATE LICENSE
MI
Enumeration date
04/20/2006
Last updated
06/09/2010
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