Provider Demographics
NPI:1740546159
Name:CLYDE WU, M.D.
Entity type:Organization
Organization Name:CLYDE WU, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUCHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-506-6835
Mailing Address - Street 1:1275 AUDUBON RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1151
Mailing Address - Country:US
Mailing Address - Phone:313-506-6835
Mailing Address - Fax:
Practice Address - Street 1:1275 AUDUBON RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1151
Practice Address - Country:US
Practice Address - Phone:313-506-6835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICW025720207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
060067730OtherRRMC
MI104389010Medicaid
1108296182OtherBCBSM
1108296182OtherBCBSM