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Contact Information

JOHN M WILSON, MD
1850 BLUEGRASS AVE
LOUISVILLE, KY40215
 Phone: 502-361-6617
 Fax: 502-361-6637
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for JOHN M WILSON · (Male)

NPI Number 1114227139
Status Active
Credentials MD
Entity Individual
Enumeration date 10/25/2010
Last updated 08/29/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • KY License # 47643
  • KY License # TP926
  • KY Medicaid 7100323720
  • KY Other K153505 MEDICARE PIN
Hospital affiliation(s)
  • JEWISH HOSPITAL & ST MARY'S HEALTHCARE - (Acute Care)
    200 ABRAHAM FLEXNER WAY
    LOUISVILLE, KY 40202
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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