Healthcare Provider Details

I. General information

NPI: 1033227095
Provider Name (Legal Business Name): JAMES R. WILSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S HUGHSTON ST
MC BAIN MI
49657-9622
US

IV. Provider business mailing address

PO BOX 87
CADILLAC MI
49601-0087
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-6076
  • Fax: 231-775-0027
Mailing address:
  • Phone: 231-775-6076
  • Fax: 231-775-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES R WILSON
Title or Position: OWNER
Credential: DO
Phone: 231-775-6076