Organization
R.L. WILSON, M.D., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKEY L WILSON M.D. (PRESIDENT)
(574) 233-5858
Entity
Organization
Contact information
Practice address
828 E COLFAX AVE, SOUTH BEND, IN 46617-2804
(574) 233-5858
Mailing address
828 E COLFAX AVE, SOUTH BEND, IN 46617-2804
(574) 233-5858
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
50003038A
IN
Other
Enumeration date
05/02/2007
Last updated
09/11/2025
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