Individual
ROBERT WICHLACZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
3041 CHARLEVOIX DR SE, GRAND RAPIDS, MI 49546-7035
(616) 942-7200
Mailing address
3041 CHARLEVOIX DR SE, GRAND RAPIDS, MI 49546-7035
(616) 942-7200
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5501006967
MI
225100000X
Physical Therapist
5501006967
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501006967
BOB STATE
MI
01
—
650G011440
BOB BCBSMI
MI
Enumeration date
02/17/2006
Last updated
08/20/2019
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