Provider Demographics
NPI:1023331782
Name:JAMES E. WILSON MD SC
Entity type:Organization
Organization Name:JAMES E. WILSON MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, JAMES E. WILSON, M.D. S.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-922-7575
Mailing Address - Street 1:122 SOUTH MICHIGAN AVE.
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603
Mailing Address - Country:US
Mailing Address - Phone:312-922-7575
Mailing Address - Fax:
Practice Address - Street 1:122 SOUTH MICHIGAN AVE.
Practice Address - Street 2:SUITE 1300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603
Practice Address - Country:US
Practice Address - Phone:312-922-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty