Hallie J Wilson, DO
Individual provider Active NPI Family Medicine Physician · Ithaca, MI
NPI 1003881053 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003881053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5101011981 (MI)
- Practice address
- 114 N Main St
Ithaca, MI 48847 - Phone
- (989) 875-4166
- Fax
- (989) 875-3600
- NPI assigned
- Feb 22, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101011981 | MI | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101011981 | MI | Yes |
Addresses
Primary practice location
114 N Main St
Ithaca, MI 48847
Mailing address
PO Box 730
406 E Elm St
Carson City, MI 48811
Phone (989) 584-3131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3381288 | Medicaid | MI |
Other providers in Ithaca, MI
- James Randolph Tilton Jr.
- Trauma and Addiction Solutions PLLC
- Shelby Vanscoyoc
- Carol A Waters
- William McCarthy, Inc.
- Paul E Worley Jr.
- Teressa Annette Yordy
All providers in Ithaca, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.