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General NPI Number Information
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NPI Number | 1104985001
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Entity Type | Organization
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Legal Business Name | CERTIFIED EMERGENCY MEDICINE SPECIALISTS, PC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 5900 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519
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Country | US
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Telephone | 616-363-7867
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Fax | 616-363-9432
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Provider Business Mailing Address
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Address Line | PO BOX 72011
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City | CLEVELAND
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State | OH
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Zip | 44192-0002
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Country | US
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Telephone | 616-363-7867
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Fax | 616-363-9432
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Authorized Official
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Title or Position | PROVIDER CREDENTIALING
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Name | MRS. SONYA D WILSON
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Credential |
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Telephone | 616-363-7867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State | MI
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