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Individual

DR. STEPHEN WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
24345 HARPER AVE, ST CLAIR SHORES, MI 48080
(586) 563-3300
(586) 563-3313
Mailing address
PO BOX 806325, ST CLAIR SHORES, MI 48080
(586) 563-3300
(586) 563-3313

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
SW061846
MI
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
SW061846
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1932129319
DMENSION
MI
01
2505012031
BCBS OF MI
MI
05
4332250
MI
05
4332250 10
MI
01
540E019050
BCBSM DME
MI
01
5614160001
MC NCS
MI
Enumeration date
06/20/2005
Last updated
07/23/2008
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