Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301023556 | MI |
Y | 208600000X | Surgeon | 4301023556 | MI |
N | 2086S0102X | Surgical Critical Care | 4301023556 | MI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 4301023556 | MI |
NPI | 1194765651 |
---|---|
Provider Name | Robert F Wilson |
First Address | Troy, MI 48083-1189 |
Second Address | Detroit, MI 48201-2020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 06/02/2014 |