Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 65904 | WI |
Y | 111NI0900X | Internist | 65904 | WI |
NPI | 1003287079 |
---|---|
Provider Name | Dr. Jeffrey Wilson |
First Address | Milwaukee, WI 53233-1308 |
Second Address | Milwaukee, WI 53233-1308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2015 |
Last Update Date | 01/11/2016 |