Provider Demographics
NPI:1952408957
Name:WILSON, AARON L (DO)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:L
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17830 FREDERICKTOWN AMITY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-8602
Mailing Address - Country:US
Mailing Address - Phone:317-580-6309
Mailing Address - Fax:
Practice Address - Street 1:7440 WOODLAND DR DEPT 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1720
Practice Address - Country:US
Practice Address - Phone:317-580-6309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089080Medicaid
OH0089080Medicaid