Individual
BARBARA N WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
2537 MOMENTUM PL, CHICAGO, IL 60689-5325
(616) 975-1845
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301049918
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301049918
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930001004
RAILROAD MEDICARE
MI
Enumeration date
08/03/2006
Last updated
04/27/2012
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