Individual
MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-1941
(313) 966-4204
Mailing address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-1941
(313) 966-4204
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
DO2874
NV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/18/2016
Last updated
04/07/2021
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