Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 054703 | GA |
N | 208600000X | Surgeon | 054703 | GA |
Y | 208200000X | Surgeon | D0067673 | MD |
Y | 208600000X | Surgeon | D0067673 | MD |
NPI | 1013997162 |
---|---|
Provider Name | Dr. Tihesha L Wilson |
First Address | Miami, FL 33133-4205 |
Second Address | Miami, FL 33133-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 17/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1942236 | AETNA PPO (01) | |
4153308 | (05) | MD |
58860013 | CAREFIRST BLE CHOICE (01) | |
7224577 | AETNA HMO (01) | |
767420679A | (05) | GA |
I24397 | (02) | GA |
K313BR94043801 | CAREFIRST MARYLAND (01) |