Healthcare Provider Details

I. General information

NPI: 1972533396
Provider Name (Legal Business Name): DAVID K WILSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E SAVIDGE ST
SPRING LAKE MI
49456-1957
US

IV. Provider business mailing address

622 E SAVIDGE ST
SPRING LAKE MI
49456-1957
US

V. Phone/Fax

Practice location:
  • Phone: 616-213-0253
  • Fax: 616-296-2423
Mailing address:
  • Phone: 616-213-0253
  • Fax: 616-296-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301060071
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: