Organization
WYANDOTTE PHYSICIAN PRACTICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KIBBLE (DIRECTOR)
(313) 874-3436
Entity
Organization
Contact information
Practice address
15101 SOUTHFIELD RD, ALLEN PARK, MI 48101-2697
(248) 489-4502
(248) 489-4503
Mailing address
PO BOX 674102, DETROIT, MI 48267-4102
(800) 827-3797
(248) 489-2108
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
09/17/2008
Last updated
09/17/2008
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