Provider Demographics
NPI:1427145986
Name:WILSON, WENDY MEADE (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MEADE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 PARKDALE PLACE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6600
Mailing Address - Country:US
Mailing Address - Phone:317-329-7050
Mailing Address - Fax:317-328-6809
Practice Address - Street 1:6820 PARKDALE PLACE
Practice Address - Street 2:SUITE 211
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6600
Practice Address - Country:US
Practice Address - Phone:317-329-7050
Practice Address - Fax:317-328-6809
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057248207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200441010Medicaid
IN000000279117OtherANTHEM
IN200441010Medicaid
IN208230Medicare ID - Type Unspecified