Individual
DR. TERRY A WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14103 FENKELL ST, DETROIT, MI 48227-3214
(313) 397-6006
(313) 397-6368
Mailing address
14103 FENKELL ST, DETROIT, MI 48227-3214
(313) 397-6006
(313) 397-6368
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301080116
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3042185
MEDICARE PTAN
TN
05
—
5226815
—
MI
Enumeration date
08/25/2006
Last updated
08/24/2015
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