Healthcare Provider Details

I. General information

NPI: 1740700459
Provider Name (Legal Business Name): THOMAS STANLEY WENZLICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E PARIS AVE SE STE 240
GRAND RAPIDS MI
49546-6117
US

IV. Provider business mailing address

2144 E PARIS AVE SE STE 240
GRAND RAPIDS MI
49546-6117
US

V. Phone/Fax

Practice location:
  • Phone: 989-274-0082
  • Fax:
Mailing address:
  • Phone: 989-274-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301112690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: