Healthcare Provider Details

I. General information

NPI: 1548211592
Provider Name (Legal Business Name): DAVID K WASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18463 LIVERNOIS AVE
DETROIT MI
48221-2254
US

IV. Provider business mailing address

18000 W 9 MILE RD STE 200
SOUTHFIELD MI
48075-4020
US

V. Phone/Fax

Practice location:
  • Phone: 313-369-1500
  • Fax: 248-336-9137
Mailing address:
  • Phone: 248-336-4000
  • Fax: 248-336-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301079200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: