MEDICARE: JAMES WILSON M.S.

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	231H00000X	Audiologist	23002413	IN

General Provider Information

NPI Number	:	1659593903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WILSON M.S.

Provider Business Mailing Address
First Line	:	1523 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-899-4511
Fax Number	:	317-899-4512

Provider Business Practice Location Address
First Line	:	1523 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-899-4511
Fax Number	:	317-899-4512

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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