Wilson, Frederick Mike

Wilson, Frederick Mike is an individual health care provider with primary practice located at 2613 Fairway Dr , Fulton MO 65251. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Wilson, Frederick Mike can be contacted via phone (573) 642-4242.

Contact Information

Primary practice address
2613 Fairway Dr Fulton MO 65251
Phone: (573) 642-4242
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 113229 Missouri
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 113229 Missouri

Profile Details

NPI number 1609806173
LBN Legal business name Wilson, Frederick Mike
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2006
Last updated Feb 10th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609806173 NPPES
Missouri MEDICAID 207326307

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