Provider Demographics
NPI:1801239892
Name:WILSON, WILLIAM HENRY IV (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:WILSON
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:986 EARLEY LAKE PL
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6203
Mailing Address - Country:US
Mailing Address - Phone:513-253-7542
Mailing Address - Fax:
Practice Address - Street 1:760 MILITARY HWY BLDG 840
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55450-2100
Practice Address - Country:US
Practice Address - Phone:612-713-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN623622083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine