Individual
MR. ROBERT LEESON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 731-8900
(920) 225-1479
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 738-4780
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
26620-020
WI
207RC0000X
Cardiovascular Disease Physician
Primary
26620-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30638900
—
WI
Enumeration date
05/15/2006
Last updated
01/28/2011
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