Individual
DR. STEPHEN TODD WYSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 JOHN ST, SUITE M-283, KALAMAZOO, MI 49007-5341
(269) 349-7696
(269) 349-0610
Mailing address
601 JOHN ST, BOX 42, KALAMAZOO, MI 49007-5341
(269) 349-7696
(269) 349-0610
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301058092
MI
2086S0129X
Vascular Surgery Physician
Primary
4301058092
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020C91020
BCBS GRP PIN
MI
01
—
112048
GREAT LAKES HLTH PLN
—
05
—
3279453-10
—
MI
01
—
3403903000
BCBS IND PIN
MI
01
—
5898515
AETNA PIN
—
Enumeration date
06/17/2006
Last updated
11/27/2023
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