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General NPI Number Information
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NPI Number | 1023331782
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Entity Type | Organization
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Legal Business Name | JAMES E. WILSON MD SC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 122 SOUTH MICHIGAN AVE. SUITE 1300
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City | CHICAGO
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State | IL
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Zip | 60603
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Country | US
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Telephone | 312-922-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 122 SOUTH MICHIGAN AVE. SUITE 1300
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City | CHICAGO
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State | IL
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Zip | 60603
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Country | US
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Telephone | 312-922-7575
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, JAMES E. WILSON, M.D. S.
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Name | DR. JAMES EDWARD WILSON
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Credential | M.D.
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Telephone | 312-922-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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