Provider Demographics
NPI:1831137207
Name:WYANDOTTE MEDICAL PRACTICES
Entity Type:Organization
Organization Name:WYANDOTTE MEDICAL PRACTICES
Other - Org Name:ORTHOPAEDIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-246-6044
Mailing Address - Street 1:3200 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5937
Mailing Address - Country:US
Mailing Address - Phone:734-225-9112
Mailing Address - Fax:734-225-9176
Practice Address - Street 1:3200 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5937
Practice Address - Country:US
Practice Address - Phone:734-324-3915
Practice Address - Fax:734-324-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty