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WESLEY BLAKE VANDERLAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806

Taxonomy

Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
14789
MS
208600000X
Surgery Physician
14789
MS
208600000X
Surgery Physician
20800
ND
208600000X
Surgery Physician
Primary
4301086703
MI
2086S0102X
Surgical Critical Care Physician
14789
MS
2086S0102X
Surgical Critical Care Physician
1930
GA
2086S0102X
Surgical Critical Care Physician
MC-2691
ID
2086S0102X
Surgical Critical Care Physician
ME115495
FL
2086S0127X
Trauma Surgery Physician
14789
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00117675
MS
Enumeration date
05/02/2007
Last updated
02/10/2025
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