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General NPI Number Information
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NPI Number | 1427027861
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Entity Type | Individual
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Provider Name | JAMES M. WYNALDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 840 BROOKVILLE PLAZA SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508
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Country | US
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Telephone | 616-243-5707
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Fax | 616-243-1170
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Provider Business Mailing Address
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Address Line | 8485 ALGOMA AVE P.O.BOX 346
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City | ROCKFORD
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State | MI
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Zip | 49341
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Country | US
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Telephone | 616-863-6220
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Fax | 616-863-6221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301053498
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License Number State | MI
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