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General NPI Number Information
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NPI Number | 1689805061
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Entity Type | Individual
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Provider Name | FREDERICKA ALONA WILSON DPM, MPH
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Gender | Female
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 4010 W 86TH ST STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-1779
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Country | US
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Telephone | 317-872-3338
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Fax | 317-872-3339
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Provider Business Mailing Address
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Address Line | 8206 ROCKVILLE RD # 192
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3113
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Country | US
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Telephone | 317-872-3338
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Fax | 317-872-3339
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 07001094A
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License Number State | IN
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