Organization
WOLVERINE DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN DALE FREELAND MD (OWNER)
(210) 632-0341
Entity
Organization
Contact information
Practice address
1673 GEZON PKWY SW, WYOMING, MI 49519-9519
(616) 243-3376
(616) 243-3377
Mailing address
1673 GEZON PKWY SW, WYOMING, MI 49519-9519
(616) 243-3376
(616) 243-3377
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301084275
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D2141314
CLIA
MI
01
—
4301084275
STATE MEDICAL LICENSE
MI
Enumeration date
10/25/2017
Last updated
02/28/2023
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