Healthcare Provider Details

I. General information

NPI: 1487856787
Provider Name (Legal Business Name): MALGORZATA WIELBUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CATHERINE ST
ANN ARBOR MI
48109-2054
US

IV. Provider business mailing address

3745 FIELDCREST LN
YPSILANTI MI
48197-7462
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-8440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: