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General NPI Number Information
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NPI Number | 1467528315
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Entity Type | Organization
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Legal Business Name | CAROL Y WYSE DO PLC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 6012 LINDEN RD SUITE 14
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-8890
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Country | US
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Telephone | 810-655-5900
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Fax | 810-655-5915
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Provider Business Mailing Address
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Address Line | PO BOX 320945
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City | FLINT
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State | MI
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Zip | 48532-0017
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Country | US
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Telephone | 810-655-5900
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Fax | 810-655-5915
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROL Y WYSE
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Credential | DO
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Telephone | 810-655-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CW007869
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License Number State | MI
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