Organization
WYANDOTTE MEDICAL PRACTICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW WOLOCKO (DIRECTOR)
(734) 324-3591
Entity
Organization
Contact information
Practice address
3333 BIDDLE AVE, SUITE B, WYANDOTTE, MI 48192
(734) 282-8650
(734) 282-8651
Mailing address
3333 BIDDLE ST, SUITE C, WYANDOTTE, MI 48192-6284
(734) 282-8650
(734) 282-8651
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD2881
MEDICARE RAILROAD
—
Enumeration date
05/02/2007
Last updated
10/17/2007
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