Individual
BENNETT LEROY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-0001
(608) 263-8443
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
303347
NY
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
82161-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0039
—
NY
Enumeration date
05/24/2017
Last updated
06/25/2026
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