Individual
MRS. KIMBERLY ELIZABETH WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
52349 FOREST GRV, SHELBY TWP, MI 48315-2316
(586) 909-0148
Mailing address
52349 FOREST GRV, SHELBY TWP, MI 48315-2316
(586) 909-0148
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
06/12/2009
Last updated
07/15/2013
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