Healthcare Provider Details

I. General information

NPI: 1922107200
Provider Name (Legal Business Name): STEVEN WASKERWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 101G
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

2283 HIDDEN LAKE DR
WEST BLOOMFIELD MI
48324-1322
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-7240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301062601
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: