| R.l. Wilson, M.d., Pc | |
|
828 E Colfax Ave South Bend IN 46617-2804 | |
| (574) 233-5858 | |
| Not Available |
| Full Name | R.l. Wilson, M.d., Pc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 828 E Colfax Ave, South Bend, Indiana |
| Authorized Official Name and Position | Rickey L Wilson (PRESIDENT) |
| Authorized Official Contact | 5742335858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| R.l. Wilson, M.d., Pc 828 E Colfax Ave South Bend IN 46617-2804 Ph: (574) 233-5858 | R.l. Wilson, M.d., Pc 828 E Colfax Ave South Bend IN 46617-2804 Ph: (574) 233-5858 |
| NPI Number | 1962623249 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962623249 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 50003038A (Indiana) | Primary |
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