MEDICARE: LENNARD STEVEN 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	2084N0400X	Neurology Physician	6749	MT

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

General Provider Information

NPI Number	:	1225023096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENNARD STEVEN WILSON M.D.

Provider Business Mailing Address
First Line	:	6520 DRIFTWOOD LN
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-3218
Country	:	US
Telephone Number	:	406-251-5253
Fax Number	:	406-251-6153

Provider Business Practice Location Address
First Line	:	2835 FORT MISSOULA RD
Second Line	:	STE 203
City	:	MISSOULA
State	:	MT
Zip	:	59804-7423
Country	:	US
Telephone Number	:	406-327-4091
Fax Number	:	406-327-4590

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	04/29/2021

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