Provider Demographics
NPI:1407808793
Name:WILSON, MARK C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S HOSPITAL
Mailing Address - Street 2:8200 DODGE STREET
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4113
Mailing Address - Country:US
Mailing Address - Phone:402-955-5400
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL - RESPIRATORY MEDICINE & ALLERGY
Practice Address - Street 2:8200 DODGE STREET
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4113
Practice Address - Country:US
Practice Address - Phone:402-955-5570
Practice Address - Fax:402-955-5575
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE176582080S0012X, 2080P0214X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Not Answered2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1926246Medicaid
662OtherMIDLANDS CHOICE
IA94533OtherBCBS
SD7781510Medicaid
NE31219OtherBCBS
IA94533OtherBCBS