| David E Wilson Md Llc | |
|
190 Ne 91st St Kansas City MO 64155-3329 | |
| (816) 804-5223 | |
| Not Available |
| Full Name | David E Wilson Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 190 Ne 91st St, Kansas City, Missouri |
| Authorized Official Name and Position | David E Wilson (OWNER/PHYSICIAN) |
| Authorized Official Contact | 8168045223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David E Wilson Md Llc 190 Ne 91st St Kansas City MO 64155-3329 Ph: (816) 804-5223 | David E Wilson Md Llc 190 Ne 91st St Kansas City MO 64155-3329 Ph: (816) 804-5223 |
| NPI Number | 1619421674 |
|---|---|
| Provider Enumeration Date | 08/08/2016 |
| Last Update Date | 05/03/2024 |
| Medicare PECOS PAC ID | 3678861887 |
|---|---|
| Medicare Enrollment ID | O20161004000607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619421674 | NPI | - | NPPES |
| 110042554 | Other | MO | RAILROAD MEDICARE |
| 04489010 | Other | MO | BLUE CROSS OF KANSAS CITY INDIVIDUAL# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | R4908 (Missouri) | Primary |
| Provider Name | David E Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073583563 PECOS PAC ID: 1153454855 Enrollment ID: I20100802000708 |
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