Provider Demographics
NPI:1568344521
Name:WILSON, DUANE LOUIS
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:LOUIS
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5152 E 114TH ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2866
Mailing Address - Country:US
Mailing Address - Phone:216-224-8396
Mailing Address - Fax:216-224-8396
Practice Address - Street 1:5152 E 114TH ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2866
Practice Address - Country:US
Practice Address - Phone:216-224-8396
Practice Address - Fax:216-224-8396
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health