Individual
DR. PETER BRADLEY WENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 E PARIS AVE SE STE 200, GRAND RAPIDS, MI 49546-8383
(616) 685-3450
Mailing address
PO BOX 776974, CHICAGO, IL 60677-6974
(800) 494-5797
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301514298
MI
207RI0011X
Interventional Cardiology Physician
Primary
4301514298
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2018
Last updated
04/30/2026
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