Individual
KENNETH CARL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
234 E GRAY ST, SUITE 364, LOUISVILLE, KY 40202-1900
(502) 629-5578
(502) 629-5147
Mailing address
PO BOX 35070, LOUISVILLE, KY 40232-5070
(502) 629-5578
(502) 629-5147
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24205
KY
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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