MEDICARE: CORNELIUS A WILSON M.D.

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	J2845	TX
2	207R00000X	Internal Medicine Physician	J2845	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	87622Z	OTHER	TX	GLOBAL
3	2242072	OTHER	TX	CIGNA
4	8AJ396	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1215032586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORNELIUS A WILSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 24308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77229-4308
Country	:	US
Telephone Number	:	713-450-4455
Fax Number	:	713-450-4737

Provider Business Practice Location Address
First Line	:	12739 WOODFOREST BLVD STE 2
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-2737
Country	:	US
Telephone Number	:	713-450-4455
Fax Number	:	713-450-4737

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	09/03/2025

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