Individual
RICHARD D. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(217) 554-4186
Mailing address
2124 N 1300 EAST RD, WHITE HEATH, IL 61884-9312
(217) 687-4004
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
85-000895
IL
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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