Healthcare Provider Details

I. General information

NPI: 1568994846
Provider Name (Legal Business Name): SEAN MCFERRAN WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 N US HIGHWAY 31
COLUMBUS IN
47201-8558
US

IV. Provider business mailing address

4665 N US HIGHWAY 31
COLUMBUS IN
47201-8558
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9353
  • Fax: 812-376-3757
Mailing address:
  • Phone: 812-376-9353
  • Fax: 812-376-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number01089987A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: