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General NPI Number Information
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NPI Number | 1649239260
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Entity Type | Individual
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Provider Name | THOMAS WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 18599 LAKE SHORE BLVD
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City | CLEVELAND
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State | OH
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Zip | 44119-1093
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Country | US
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Telephone | 216-844-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 24701 EUCLID AVE 3RD FLOOR
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City | EUCLID
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State | OH
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Zip | 44117-1714
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35-049077
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35-049077
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License Number State | OH
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