Provider Demographics
NPI:1548247422
Name:WILSON, DAVID B (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1359 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4501
Mailing Address - Country:US
Mailing Address - Phone:224-588-9940
Mailing Address - Fax:224-588-9941
Practice Address - Street 1:1000 CORPORATE GROVE DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4550
Practice Address - Country:US
Practice Address - Phone:224-588-9940
Practice Address - Fax:224-588-9941
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049186A207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000191567OtherANTHEM
IN000000014566OtherMPLAN
IN200329070AMedicaid
H01532Medicare UPIN
220030226Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN200329070AMedicaid