Individual
KATHRYN A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1813 W. KIRBY AVENUE, ENDOCRINOLOGY, CHAMPAIGN, IL 61821
(217) 383-3490
(217) 383-3439
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-4752
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
036080035
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
830000434
MEDICARE RAILROAD PIN
IL
Enumeration date
09/14/2006
Last updated
05/16/2014
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