Healthcare Provider Details

I. General information

NPI: 1508950767
Provider Name (Legal Business Name): WEXFORD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N ROLAND ST
MC BAIN MI
49657-9683
US

IV. Provider business mailing address

520 COBB ST
CADILLAC MI
49601-2588
US

V. Phone/Fax

Practice location:
  • Phone: 231-825-2643
  • Fax: 231-825-0161
Mailing address:
  • Phone: 231-775-6521
  • Fax: 231-876-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ZDORODWSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 231-876-6730