Individual
MICHAEL N WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6365 W OKMULGEE ST, MUSKOGEE, OK 74401-4595
(918) 682-8407
Mailing address
140 W 60TH PL S, MUSKOGEE, OK 74401-9031
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/20/2018
Last updated
01/20/2018
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