Healthcare Provider Details

I. General information

NPI: 1679198436
Provider Name (Legal Business Name): JOSEPH H WILSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 N ELM ST
HENDERSON KY
42420-2938
US

IV. Provider business mailing address

PO BOX 3366
EVANSVILLE IN
47732-3366
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-7199
  • Fax:
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number265917
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number41000415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: