Individual
DR. MATTHEW J WIETRZYKOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9230 JOSEPH CAMPAU ST, HAMTRAMCK, MI 48212-3731
(313) 875-9270
(313) 875-9420
Mailing address
9230 JOSEPH CAMPAU ST, HAMTRAMCK, MI 48212-3731
(313) 875-9270
(313) 875-9420
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301063858
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022808
MIDWEST HEALTH PLAN
MI
01
—
1108269932
BCBS
MI
01
—
151659
GREAT LAKES
MI
05
—
1528040979
—
MI
05
—
4391529
—
MI
01
—
5458769
AETNA
MI
01
—
G76852
HAP
MI
01
—
P00029377
RAILROAD MEDICARE
MI
Enumeration date
11/18/2005
Last updated
06/14/2019
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