MEDICARE: SUSAN D 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
1	237700000X	Hearing Instrument Specialist	3501003110	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558375956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN D WILSON

Provider Business Mailing Address
First Line	:	PO BOX 406153
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-1876
Country	:	US
Telephone Number	:	989-345-7550
Fax Number	:	989-345-7590

Provider Business Practice Location Address
First Line	:	110 BEECH ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-8314
Country	:	US
Telephone Number	:	989-362-8196
Fax Number	:	989-362-0967

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	01/14/2009

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Directions to “ SUSAN D WILSON ” Practice Location

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