Individual
MICHAEL K. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
71 HOSPITAL AVE, NORTH ADAMS, MA 01247-2504
(413) 664-5000
Mailing address
71 HOSPITAL AVE, NORTH ADAMS, MA 01247-2504
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
220691
MA
208000000X
Pediatrics Physician
220691
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010747
—
VT
05
—
2076683
—
MA
Enumeration date
12/29/2005
Last updated
09/28/2007
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