Doctor Name: | SEAN E WILSON |
NPI Number: | 1114917812 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 780025 |
Business Practice Address: | 2424 S 90th St Suite 500 West Allis, WI - 532272455 |
Business Phone Number: | 4143288600 |
Business Fax Number: | 4143288686 |
Mailing Address: | 19475 W North Ave, Suite 201 BROOKFIELD |
State: | WI |
Postal Code: | 530454199 |
Phone Number: | 2627804400 |
Fax Number: | 2627804425 |
NPI Enumeration Date: | 10/24/2005 |
NPI Last Update Date: | 01/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 780025 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |