Search › Kentucky › 1710I1003X
Mark Wilson, IDMT
NPI 1518313089 · on the registry since 2016
Practice
- Address
- 1101 Grade Ln
123 Special Tactics
Louisville, KY 40213 - Phone
- (502) 413-4836
- Clinicians at this address
- 4
Registry record
- Primary taxonomy
- 1710I1003X
1710I1003X
- Sex
- Male
- Record last updated
- 2016-05-13
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Kentucky