Healthcare Provider Details

I. General information

NPI: 1033563101
Provider Name (Legal Business Name): ANDREA WAIT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA ROSE BEDWAY

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

21458 MORNINGSIDE DR
GROSSE POINTE WOODS MI
48236-1257
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-0254
  • Fax:
Mailing address:
  • Phone: 313-910-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351037013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: