Individual
KEVIN ANTHONY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1613 HARRISON PKWY, #200, SUNRISE, FL 33323-2853
(954) 838-2371
Mailing address
PO BOX 848508, PEMBROKE PINES, FL 33084-0508
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS9530
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16234
BCBS
FL
05
—
272737400
—
FL
Enumeration date
01/12/2006
Last updated
04/26/2021
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