Provider Demographics
NPI:1659416253
Name:WL PHYSICIANS P.C.
Entity Type:Organization
Organization Name:WL PHYSICIANS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:248-284-1760
Mailing Address - Street 1:1385 E. 12 MILE RD. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON HIEGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-284-1760
Mailing Address - Fax:248-284-1780
Practice Address - Street 1:1385 E 12 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2649
Practice Address - Country:US
Practice Address - Phone:248-284-1760
Practice Address - Fax:248-284-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033364208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020E018760OtherBLUE CROSS BLUE SHIELD
MI104997338Medicaid
MI104997338Medicaid