Individual
TOD WYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
270 HOOVER BLVD, HOLLAND, MI 49423-3719
(616) 396-2972
(616) 396-2808
Mailing address
270 HOOVER BLVD, HOLLAND, MI 49423-3719
(616) 396-2972
(616) 396-2808
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301060023
MI
207PH0002X
Hospice and Palliative Medicine (Emergency Medicine) Physician
4301060023
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073537403
—
MI
01
—
930017975
RAILROAD MEDICARE
MI
01
—
TW060023
BCBS
MI
Enumeration date
07/27/2006
Last updated
12/17/2025
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