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NPI Code Detail

MEDICARE: ALFRED WILSON

MEDICARE: ALFRED WILSON
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
1347C00000XPrivate Vehicle

General Provider Information

NPI Number : 1467311399
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFRED WILSON
Provider Business Mailing Address
First Line : 15302 KENTFIELD ST
Second Line :
City : DETROIT
State : MI
Zip : 48223-1749
Country : US
Telephone Number : 313-492-7321
Fax Number :
Provider Business Practice Location Address
First Line : 15302 KENTFIELD ST
Second Line :
City : DETROIT
State : MI
Zip : 48223-1749
Country : US
Telephone Number : 313-492-7321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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Directions to “ ALFRED WILSON ” Practice Location

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