1538335351 NPI number — DANIEL J WECHTER MD PC

Table of content: (NPI 1538335351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538335351 NPI number — DANIEL J WECHTER MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL J WECHTER MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538335351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2022
NPI Reactivation Date:
04/08/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 JOE MANN BLVD STE P-6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48642-8900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-791-2455
Provider Business Mailing Address Fax Number:
989-791-1392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 COOPER AVE
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-755-4515
Provider Business Practice Location Address Fax Number:
989-755-4516
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WECHTER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-755-4515

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  DW047758 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017308502 . This is a "HEALTH PLUS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1607310051 . This is a "BCN PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1538335351 . This is a "MEDICARE TYPE 2 BILLING NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1538335351 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1607310051 . This is a "BCBS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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