Individual
DESMONDA BRADY WIXSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4613 W MAIN ST STE A, KALAMAZOO, MI 49006-2698
(269) 488-8672
(269) 488-8673
Mailing address
4613 W MAIN ST STE A, KALAMAZOO, MI 49006-2698
(269) 488-8672
(269) 488-8673
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301072883
MI
208000000X
Pediatrics Physician
4301072883
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4605400
—
MI
Enumeration date
07/03/2006
Last updated
02/07/2022
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