Healthcare Provider Details

I. General information

NPI: 1902858418
Provider Name (Legal Business Name): STUART D WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE SURGICAL ONCOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE SURGICAL ONCOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5020
  • Fax: 414-805-5771
Mailing address:
  • Phone: 414-805-5020
  • Fax: 414-805-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14144
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number14144
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: