Provider Demographics
NPI:1093256398
Name:WILSON, DARRYL JR
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41521 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1803
Mailing Address - Country:US
Mailing Address - Phone:248-299-0030
Mailing Address - Fax:248-912-1566
Practice Address - Street 1:16712 HUFFMEISTER RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-8050
Practice Address - Country:US
Practice Address - Phone:248-299-0030
Practice Address - Fax:248-912-1566
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other