Provider Demographics
NPI:1659368009
Name:WILSON, INGRID N (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:N
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-458-3288
Mailing Address - Fax:734-458-3286
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-458-3288
Practice Address - Fax:734-458-3286
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2017-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301405574207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4702647Medicaid
MI4702647Medicaid
MI0Q26334057Medicare ID - Type Unspecified