Provider Demographics
NPI:1891099461
Name:ROBERT F WILSON JR MD LTD
Entity Type:Organization
Organization Name:ROBERT F WILSON JR MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:630-690-0650
Mailing Address - Street 1:27 W 281 GENEVA RD STE I
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2035
Mailing Address - Country:US
Mailing Address - Phone:630-690-0650
Mailing Address - Fax:630-690-0713
Practice Address - Street 1:27W281 GENEVA RD STE I
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2085
Practice Address - Country:US
Practice Address - Phone:630-690-0650
Practice Address - Fax:630-690-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336011207208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL309380Medicare PIN
D86667Medicare UPIN