MEDICARE: DR. DARYL D 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	207P00000X	Emergency Medicine Physician	036-100397	IL

General Provider Information

NPI Number	:	1346309150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARYL D WILSON M.D.

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 W LAKE ST
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-2586
Country	:	US
Telephone Number	:	630-527-3645
Fax Number	:

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	12/03/2025

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