Individual
MR. LUCAS JOHN WYZLIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
621 COURT STREET, SUITE 104, WEST BRANCH, MI 48661
(989) 701-2293
Mailing address
4238 LAKESIDE DRIVE, WEST BRANCH, MI 48661
(775) 315-1022
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006424
MI
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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