Individual
MICHAEL E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
303 N CLYDE MORRIS BLVD, INTENSIVIST SERVICES, DAYTONA BEACH, FL 32114-2709
(386) 425-4152
(386) 425-4315
Mailing address
303 N CLYDE MORRIS BLVD, CREDENTIAL SERVICES, DAYTONA BEACH, FL 32114-2709
(386) 425-4152
(386) 425-4315
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
53237
MN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
ME145800
FL
207RP1001X
Pulmonary Disease Physician
53237
MN
Other
Enumeration date
09/08/2009
Last updated
09/08/2020
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