Healthcare Provider Details

I. General information

NPI: 1275581654
Provider Name (Legal Business Name): DR JAMES E WILSON SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EAST 75TH STREET SUITE 110
NAPERVILLE IL
60565-1469
US

IV. Provider business mailing address

PO BOX 378
ORLAND PARK IL
60462-0378
US

V. Phone/Fax

Practice location:
  • Phone: 887-873-7546
  • Fax: 877-893-7546
Mailing address:
  • Phone: 773-433-3838
  • Fax: 708-301-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036078688
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES EDWARD WILSON
Title or Position: PRESIDENT
Credential: MD
Phone: 877-873-7546