Wilson, Bradley A

Wilson, Bradley A is an individual health care provider with primary practice located at 1000 Health Center Dr Ste 101 , Mattoon IL 61938-4644. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Wilson, Bradley A can be contacted via phone (217) 258-4020.

Contact Information

Primary practice address
1000 Health Center Dr Ste 101 Mattoon IL 61938-4644
Phone: (217) 258-4020
Fax: (217) 258-4023
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 2005016227 Missouri
Allopathic & Osteopathic Physicians / Surgery 208600000X 36118588 Illinois

Profile Details

NPI number 1528046141
LBN Legal business name Wilson, Bradley A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2006
Last updated Apr 15th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528046141 NPPES
Illinois Other 208959 MEDICARE GRP NUMBER
Illinois MEDICAID 207215500 MEDICARE GRP NUMBER
Illinois Other 207988 MEDICARE GRP NUMBER
Illinois Other CE9335 MEDICARE GRP NUMBER
Illinois Other P00396925 MEDICARE GRP NUMBER
Illinois Other 718653 MEDICARE GRP NUMBER
Illinois Other 7470693 MEDICARE GRP NUMBER
Illinois Other I37919 MEDICARE GRP NUMBER

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