Individual
DR. ELINE HAENEBALCKE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3750 WOODWARD AVE, STE 200C, DETROIT, MI 48201-2007
(313) 993-4645
(313) 993-4654
Mailing address
1420 STEPHENSON HWY, SUITE 400-CREDENTIALING, TROY, MI 48083-1189
(248) 581-5970
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301100277
MI
207V00000X
Obstetrics & Gynecology Physician
A116814
CA
Other
Enumeration date
05/17/2007
Last updated
12/21/2021
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