Mark Wilson, IDMT

NPI #1518313089 in Louisville, Kentucky

Provider Information

NPI Number: 1518313089
Entity Type: Individual
Name: Mark Wilson, IDMT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Military Health Care Provider - Independent Duty Medical Technicians
Credential: IDMT
Enumeration Date: May 13, 2016
Last Updated: May 13, 2016

Practice Location

Address: 1101 GRADE LN
Address 2: 123 SPECIAL TACTICS
City: Louisville
State: Kentucky
ZIP Code: 40213-2673
Phone: (502) 413-4836

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Military Health Care Provider - Independent Duty Medical Technicians — Independent Duty Medical Technicians	1710I1003X	Primary

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