Individual
SUSAN W WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7430 N SHADELAND AVE, INDIANAPOLIS, IN 46250-2070
(317) 841-8005
(317) 567-2191
Mailing address
PO BOX 3041, INDIANAPOLIS, IN 46206-3041
(317) 567-2180
(317) 567-2191
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01031981
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237890
—
IN
Enumeration date
04/13/2006
Last updated
01/12/2010
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