Healthcare Provider Details

I. General information

NPI: 1982636072
Provider Name (Legal Business Name): JAMES M WILSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 SMITH RD SUITE 300
CINCINNATI OH
45209-1957
US

IV. Provider business mailing address

4030 SMITH RD SUITE 300
CINCINNATI OH
45209-1957
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-3494
  • Fax: 513-345-2606
Mailing address:
  • Phone: 513-421-3494
  • Fax: 513-345-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35045157W
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21244
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35045157W
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number21244
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: