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General NPI Number Information
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NPI Number | 1851547434
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Entity Type | Organization
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Legal Business Name | WYANDOTTE PHYSICIAN PRACTICES
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 1848 BIDDLE AVE SUITE 101
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City | WYANDOTTE
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State | MI
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Zip | 48192-3962
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Country | US
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Telephone | 734-284-2600
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Fax | 734-284-2666
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Provider Business Mailing Address
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Address Line | PO BOX 674102
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City | DETROIT
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State | MI
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Zip | 48267-0001
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Country | US
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Telephone | 800-827-3797
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Fax | 248-553-2108
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOHN E KIBBLE
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Credential |
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Telephone | 313-874-3436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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