# WANSOM MEDICAL CENTER, P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902061799
- **Authorized official:** DR. CHATE WANSOM M.D. (PRESIDENT)
- **Authorized official phone:** (734) 242-3060

## Contact information

- **Practice address:** 1492 N MONROE ST, MONROE, MI 48162-4210
- **Practice address phone:** (734) 242-3060
- **Practice address fax:** (734) 242-3062
- **Mailing address:** 1492 N MONROE ST, MONROE, MI 48162-4210
- **Mailing address phone:** (734) 242-3060
- **Mailing address fax:** (734) 242-3062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301038906 | MI | Yes |

## Other

- **Enumeration date:** 07/22/2008
- **Last updated:** 07/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0580012 | BCBS | MI |
| 05 | — | 1395936 | — | MI |