NPI 1518313089

Mark Wilson, IDMT

Practitioner Independent Duty Medical Technicians Louisville, KY

Practice location

Address: 1101 Grade Ln 123 Special Tactics, Louisville, KY 40213-2673
Phone: (502) 413-4836
Mailing address: 2200 Mammoth Way, Louisville, KY 40299-2611

Registered specialties

Independent Duty Medical Technicians Primary

Other Service Providers Taxonomy 1710I1003X

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Registry record

NPI: 1518313089
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 May 2016
Record last updated: 13 May 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.