Active NPI
Jeffrey John Wilson, AT/L
- Athletic Trainer
- Novi, MI
National Provider Identifier
1962955435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 542199
- Practice address
- 24062 Taft Rd
Novi, MI 48375-3022 - Phone
- (408) 806-2583
- NPI assigned
- Aug 1, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 542199 | MI | Primary |
Addresses
Primary practice location
24062 Taft Rd
Novi, MI 48375-3022
Mailing address
37480 Scotsdale Cir
#301
Westland, MI 48185-7553
Phone (408) 806-2583
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 542199 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470009600000",
"number": "1962955435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37480 SCOTSDALE CIR",
"address_2": "#301",
"city": "WESTLAND",
"state": "MI",
"postal_code": "481857553",
"telephone_number": "408-806-2583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24062 TAFT RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483753022",
"telephone_number": "408-806-2583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JEFFREY",
"middle_name": "JOHN",
"credential": "AT/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-01",
"last_updated": "2016-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "542199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.