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Individual

DR. JAMES M. WYNALDA

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
840 BROOKVILLE PLAZA SE, GRAND RAPIDS, MI 49508
(616) 243-5707
(616) 243-1170
Mailing address
8485 ALGOMA AVE, P.O.BOX 346, ROCKFORD, MI 49341
(616) 863-6220
(616) 863-6221

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301053498
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11292441
CAQH
MI
05
4737974
MI
Enumeration date
03/17/2006
Last updated
07/09/2007
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