Healthcare Provider Details

I. General information

NPI: 1376678417
Provider Name (Legal Business Name): MARC LLYOD WILTSHIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOWER NORY HILL ROAD CHC
SAIPAN MP
96950
US

IV. Provider business mailing address

62 ISLAND SHORE BLVD
WINNIPEG MANITOBA
R3X1LS
CA

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax: 670-236-8600
Mailing address:
  • Phone: 204-291-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0154
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: