Provider Demographics
NPI:1467828350
Name:WILSON, MICHAEL (BS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17321 TELEGRAPH ROAD
Mailing Address - Street 2:DEVELOPMENT CENTERS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-255-0900
Mailing Address - Fax:313-255-3465
Practice Address - Street 1:30500 SOUTHFIELD ROAD APT. 200
Practice Address - Street 2:MICHAEL WILSON
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:313-255-0900
Practice Address - Fax:313-255-3465
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker