# WYANDOTTE MEDICAL PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northline Womans Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518261957
- **Authorized official:** JACOB BUDD (ADMINISTRATOR OUTPATIENT SERVICES)
- **Authorized official phone:** (734) 246-8803

## Contact information

- **Practice address:** 15675 NORTHLINE RD, SOUTHGATE, MI 48195-2334
- **Practice address phone:** (734) 282-3600
- **Practice address fax:** (734) 282-3603
- **Mailing address:** 15675 NORTHLINE RD, SOUTHGATE, MI 48195-2334
- **Mailing address phone:** (734) 282-3600
- **Mailing address fax:** (734) 282-3603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/28/2010
- **Last updated:** 09/30/2011