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General NPI Number Information
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NPI Number | 1922193960
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Entity Type | Organization
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Legal Business Name | METROPOLITAN MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 9230 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3731
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Country | US
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Telephone | 313-875-9270
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Fax | 313-875-9420
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Provider Business Mailing Address
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Address Line | 9230 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3731
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Country | US
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Telephone | 313-875-9270
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Fax | 313-875-9420
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MATTHEW WIETRZYKOWSKI
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Credential | MD
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Telephone | 313-875-9270
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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 | 4301081423
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301063858
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License Number State | MI
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