Organization
CAROL Y WYSE DO PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL Y WYSE DO (PRESIDENT)
(810) 655-5900
Entity
Organization
Contact information
Practice address
6012 LINDEN RD, SUITE 14, SWARTZ CREEK, MI 48473-8890
(810) 655-5900
(810) 655-5915
Mailing address
PO BOX 320945, FLINT, MI 48532-0017
(810) 655-5900
(810) 655-5915
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
CW007869
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080139268
RR MEDICARE
—
05
—
4079297
—
MI
01
—
5250325
BCBS
—
Enumeration date
11/24/2006
Last updated
11/03/2011
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