Healthcare Provider Details

I. General information

NPI: 1275952962
Provider Name (Legal Business Name): WENDY LUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S STATE ST STE 215
ANN ARBOR MI
48104-7103
US

IV. Provider business mailing address

1346 ROSS LN
ROCHESTER MI
48306-4813
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-3990
  • Fax: 734-547-3980
Mailing address:
  • Phone: 517-897-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301500240
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: