Individual
MICHAEL J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
(317) 488-2020
Mailing address
3401 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01058771A
IN
208000000X
Pediatrics Physician
01058771A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200309370
—
IN
Enumeration date
05/09/2006
Last updated
09/15/2023
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