MEDICARE: DR. TIHESHA L WILSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	054703	GA
2	208600000X	Surgery Physician	D0067673	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1942236	OTHER	AETNA PPO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7224577	OTHER	AETNA HMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	K313BR94043801	OTHER	CAREFIRST MARYLAND
6	58860013	OTHER	CAREFIRST BLE CHOICE

General Provider Information

NPI Number	:	1013997162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIHESHA L WILSON MD

Provider Business Mailing Address
First Line	:	3641 S MIAMI AVE
Second Line	:	SUITE 331
City	:	MIAMI
State	:	FL
Zip	:	33133-4205
Country	:	US
Telephone Number	:	305-285-5040
Fax Number	:	305-285-5039

Provider Business Practice Location Address
First Line	:	3641 S MIAMI AVE
Second Line	:	SUITE 331
City	:	MIAMI
State	:	FL
Zip	:	33133-4205
Country	:	US
Telephone Number	:	305-285-5040
Fax Number	:	305-285-5039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	06/17/2011

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Directions to “ DR. TIHESHA L WILSON MD” Practice Location

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