Larry A Wickless M.D.

NPI 1033189071 - Internal Medicine - 207RG0100X

NPI Details
NPI 1033189071
Gender Male
Enumeration Date 01/24/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
28080 GRAND RIVER AVE
SUITE 306
FARMINGTON HILLS MI, 48336-5966, US
Phone (248) 471-8982
Fax (248) 426-7350
Business Location
28080 GRAND RIVER AVE
SUITE 306
FARMINGTON HILLS MI, 48336-5966, US
Phone (248) 471-8982
Fax (248) 426-7350
Toxanomy
Taxonomy Code 207RG0100X
License State Michigan
License Number 5101005865
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According to our database, Larry A Wickless M.D. NPI is 1033189071, taxonomy code is 207RG0100X and license number is 5101005865, license state is located at Michigan. Larry A Wickless M.D. physically located at 28080 Grand River Ave, Farmington Hills MI, 48336-5966. NPI Number Larry A Wickless M.D. has the Individual type.

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1033189071 NPI number is provided on an as is basis without warranty of any kind. 1033189071 is maintained by the National Plan & Provider Enumeration System. The contents of Larry A Wickless M.D. are for informational purposes only.