Provider Demographics
NPI:1518038850
Name:WILSON, ROBERT F JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:27W281 GENEVA RD STE I
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2085
Mailing Address - Country:US
Mailing Address - Phone:630-690-0650
Mailing Address - Fax:630-690-0713
Practice Address - Street 1:693 SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-3619
Practice Address - Country:US
Practice Address - Phone:630-469-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD86667Medicare UPIN
IL309380Medicare ID - Type Unspecified