Healthcare Provider Details

I. General information

NPI: 1063231454
Provider Name (Legal Business Name): ADAM WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E PRESCOTT RD
SALINA KS
67401-7408
US

IV. Provider business mailing address

651 E PRESCOTT RD
SALINA KS
67401-7408
US

V. Phone/Fax

Practice location:
  • Phone: 785-825-7251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-12891
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: