Organization
WYANDOTTE MEDICAL PRACTICES
Active
Other names
Bariatric Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW WOLOCKO (DIRECTOR)
(734) 324-3591
Entity
Organization
Contact information
Practice address
3333 BIDDLE ST, STE C, WYANDOTTE, MI 48192-6284
(734) 285-7420
(734) 285-7386
Mailing address
3333 BIDDLE ST, STE C, WYANDOTTE, MI 48192-6284
(734) 285-7420
(734) 285-7386
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301063383
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020H224840
BLUE CROSS BLUE SHIELD
MI
01
—
DD2881
MEDICARE RAILROAD
—
Enumeration date
04/23/2007
Last updated
11/12/2008
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