MEDICARE: DR. ROBERT F WILSON JR. M.D.

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
1	363AS0400X	Surgical Physician Assistant		IL

General Provider Information

NPI Number	:	1518038850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT F WILSON JR. M.D.

Provider Business Mailing Address
First Line	:	27W281 GENEVA RD STE I
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-2085
Country	:	US
Telephone Number	:	630-690-0650
Fax Number	:	630-690-0713

Provider Business Practice Location Address
First Line	:	693 SAINT CHARLES RD
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-3619
Country	:	US
Telephone Number	:	630-469-5439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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