Healthcare Provider Details

I. General information

NPI: 1699354316
Provider Name (Legal Business Name): KARLYN DEANNE WALDECK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARLIE DEANNE WALDECK DO

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST
ADRIAN MI
49221-1759
US

IV. Provider business mailing address

24272 CHARLES DR
BROWNSTOWN TWP MI
48183-2585
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-1800
  • Fax:
Mailing address:
  • Phone: 419-309-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.016760
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101028160
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: