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NPI Code Detail

MEDICARE: DARRYL WILSON JR.

MEDICARE: DARRYL WILSON JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1247200000XOther Technician

General Provider Information

NPI Number : 1093256398
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRYL WILSON JR.
Provider Business Mailing Address
First Line : 41521 W 11 MILE RD
Second Line :
City : NOVI
State : MI
Zip : 48375-1803
Country : US
Telephone Number : 248-299-0030
Fax Number : 248-912-1566
Provider Business Practice Location Address
First Line : 16712 HUFFMEISTER RD
Second Line :
City : CYPRESS
State : TX
Zip : 77429-8050
Country : US
Telephone Number : 248-299-0030
Fax Number : 248-912-1566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2017
Last Update Date : 06/28/2023

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