Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 051295 | MI |
N | 213EG0000X | General Practice | 051295 | MI |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2901015295 | MI |
NPI | 1073770855 |
---|---|
Provider Name | Albert Wesley |
First Address | Oakland, MI 48363-3032 |
Second Address | Oakland, MI 48363-3032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 31/07/2019 |