Individual
DR. MARTIN GERARD WUNSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
43211 DALCOMA DR, SUITE 11, CLINTON TOWNSHIP, MI 48038-6309
(586) 263-0947
(248) 267-5899
Mailing address
1728 BRENTWOOD DR, TROY, MI 48098-2630
(586) 263-0947
(248) 267-5899
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
6301005658
MI
103T00000X
Psychologist
6301005658
MI
103TC0700X
Clinical Psychologist
Primary
6301005658
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071777000
MAGELLAN HEALTH SERVICES
MI
01
—
122159
VALUE OPTIONS
MI
01
—
207862
MANAGED HEALTH NETWORK, I
MI
01
—
5076046
AETNA BEHAVIORAL HEALTH
MI
01
—
5842
HEALTH NET
MI
01
—
68OF33054
BLUE CROSS BLUE SHIELD
MI
01
—
IP045740
TRICARE
MI
Enumeration date
03/03/2006
Last updated
02/25/2019
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