Individual
CARISSA JANE WENTLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3901 BEAUBIEN ST # 3515, DETROIT, MI 48201-2119
(313) 745-9049
(313) 993-3879
Mailing address
3901 BEAUBIEN ST # 3515, DETROIT, MI 48201-2119
(313) 745-9049
(313) 993-3879
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01220
OH
207Y00000X
Otolaryngology Physician
2019020869
MO
207Y00000X
Otolaryngology Physician
262814
MA
207YP0228X
Pediatric Otolaryngology Physician
Primary
5101025549
MI
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
5101018847
MI
Other
Enumeration date
06/21/2010
Last updated
01/26/2024
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