Healthcare Provider Details

I. General information

NPI: 1760904585
Provider Name (Legal Business Name): DEVIN A WOLSCHON LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9844 DIXIE HWY
IRA MI
48023-2813
US

IV. Provider business mailing address

9844 DIXIE HWY
IRA MI
48023-2813
US

V. Phone/Fax

Practice location:
  • Phone: 586-716-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401016201
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: