| Doctor Name: | CHESTER WILSON |
| NPI Number: | 1548245772 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | G86678 |
| Business Practice Address: | 1668 S Us Highway 421 Westville, IN - 463919523 |
| Business Phone Number: | 8008608100 |
| Business Fax Number: | 2197853401 |
| Mailing Address: | 3975 William Richardson Dr, Suite 6695 SOUTH BEND |
| State: | IN |
| Postal Code: | 466289800 |
| Phone Number: | 8008608100 |
| Fax Number: | 5742371341 |
| NPI Enumeration Date: | 12/09/2005 |
| NPI Last Update Date: | 03/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | G86678 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |