Basic Information
| Provider Information | |||||||||
| NPI: | 1184980690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | LIZ | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50505 SCHOENHERR RD | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483153140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867318400 | ||||||||
| FaxNumber: | 5867318406 | ||||||||
| Practice Location | |||||||||
| Address1: | 50505 SCHOENHERR RD | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483153140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867318400 | ||||||||
| FaxNumber: | 5867318406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 5101019844 | MI | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 5101019844 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.