MEDICARE: THOMAS 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	207RC0000X	Cardiovascular Disease Physician	35-049077	OH
2	207R00000X	Internal Medicine Physician	35-049077	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00358874	OTHER	OH	RAILROAD MEDICARE

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	2597481	OTHER	OH	UNITED HEALTHCARE
3	341313510TW	OTHER	OH	SUMMACARE
4	4344500	OTHER	OH	AETNA
5	000000503655	OTHER	OH	ANTHEM
6	264168	OTHER	OH	FEDERAL BLACK LUNG
7	364138	OTHER	OH	WELLCARE
8	741761	OTHER	OH	BUCKEYE
10	000000130210	OTHER	OH	ANTHEM
11	000000221214	OTHER	OH	UNISON
12	18959	OTHER	OH	QUALCHOICE

General Provider Information

NPI Number	:	1649239260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WILSON MD

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18599 LAKE SHORE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-1093
Country	:	US
Telephone Number	:	216-844-3800
Fax Number	:

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	01/11/2021

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Directions to “ THOMAS WILSON MD” Practice Location

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