Healthcare Provider Details

I. General information

NPI: 1518652742
Provider Name (Legal Business Name): PATRICK TYLER WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 JUNCTION AVE
STURGIS SD
57785-2358
US

IV. Provider business mailing address

2140 JUNCTION AVE
STURGIS SD
57785-2358
US

V. Phone/Fax

Practice location:
  • Phone: 605-720-2600
  • Fax:
Mailing address:
  • Phone: 605-720-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18719
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: