Individual
DR. MASAO ROY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4717 SAINT ANTOINE ST, DETROIT, MI 48201-1423
(313) 577-8900
Mailing address
400 MACK AVE, DETROIT, MI 48201-2136
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301104424
MI
207W00000X
Ophthalmology Physician
45762
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101767100
FIRSTCARE COMMERCIAL
TX
05
—
101767101
—
TX
05
—
164556601
—
TX
05
—
1932190782
—
MI
05
—
200016600A
—
OK
05
—
74528319
—
NM
01
—
82915
PRESBYTERIAN COMMERCIAL
NM
05
—
82915
—
NM
01
—
87458Z
HMO BLUE
TX
01
—
8G7983
BC/BS
TX
01
—
D005
TRIWEST
NM
Enumeration date
11/01/2005
Last updated
02/12/2025
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