Wyandotte Physician Practices

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301080353 Issued in MI

Legal business name

WYANDOTTE PHYSICIAN PRACTICES

Practice address

21969 Huron River Dr
Rockwood, MI 48173-1237

Phone

(734) 379-1906

Fax

(734) 379-2265

NPI assigned

Nov 12, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John E Kibble

Title

Director

Phone

(313) 874-3436

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1295989564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21969 HURON RIVER DR",
            "city": "ROCKWOOD",
            "state": "MI",
            "postal_code": "481731237",
            "telephone_number": "734-379-1906",
            "fax_number": "734-379-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21969 HURON RIVER DR",
            "city": "ROCKWOOD",
            "state": "MI",
            "postal_code": "481731237",
            "telephone_number": "734-379-1906",
            "fax_number": "734-379-2265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYANDOTTE PHYSICIAN PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-12",
        "last_updated": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "KIBBLE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-874-3436"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301080353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane June Wagoner, MA
• Wellness Sexpertise Inc
• Carol Wethington
• Kristine Leeann Williams
• Benson Wong, RPH

• Family Medicine Physician in Rockwood, MI
• Providers in Rockwood, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.