Healthcare Provider Details

I. General information

NPI: 1922193960
Provider Name (Legal Business Name): METROPOLITAN MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3731
US

IV. Provider business mailing address

9230 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3731
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-9270
  • Fax: 313-875-9420
Mailing address:
  • Phone: 313-875-9270
  • Fax: 313-875-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301063858
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301081423
License Number StateMI

VIII. Authorized Official

Name: MATTHEW WIETRZYKOWSKI
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 313-875-9270