Individual
MICHAEL J WREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 459-4268
(559) 459-3553
Mailing address
4910 E CLINTON WAY, SUITE 101, FRESNO, CA 93727-1560
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA17765
CA
363AS0400X
Surgical Physician Assistant
Primary
PA17765
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPA177650
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
01/25/2007
Last updated
12/30/2021
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