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General NPI Number Information
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NPI Number | 1427220508
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Entity Type | Organization
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Legal Business Name | MICHAEL LYLE WILSON PC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 101 WALNUT ST
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City | MANISTIQUE
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State | MI
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Zip | 49854-1435
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Country | US
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Telephone | 906-341-5689
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Fax | 906-341-5723
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Provider Business Mailing Address
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Address Line | 101 WALNUT ST
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City | MANISTIQUE
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State | MI
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Zip | 49854-1435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT
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Name | MARIE BELLVILLE
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Credential |
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Telephone | 906-341-5689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 02482
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02482
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License Number State | MI
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