MEDICARE: KAREN L 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	2080A0000X	Pediatric Adolescent Medicine Physician	036103153	IL

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	:	1851390025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN L WILSON M.D.

Provider Business Mailing Address
First Line	:	3811 VALLEY CENTRE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3318
Country	:	US
Telephone Number	:	858-764-3030
Fax Number	:

Provider Business Practice Location Address
First Line	:	3811 VALLEY CENTRE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130
Country	:	US
Telephone Number	:	858-764-3030
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/24/2018

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