Provider Demographics
NPI:1972533396
Name:WILSON, DAVID K (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16986 ROBBINS RD STE 180
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2795
Mailing Address - Country:US
Mailing Address - Phone:616-213-0253
Mailing Address - Fax:616-935-8004
Practice Address - Street 1:16986 ROBBINS RD STE 180
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2795
Practice Address - Country:US
Practice Address - Phone:616-213-0253
Practice Address - Fax:616-935-8004
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MI4301060071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G15586Medicare UPIN