Healthcare Provider Details

I. General information

NPI: 1962699736
Provider Name (Legal Business Name): WENDY JOY BESLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 07/21/2022
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W GRAND BLVD STE 450
DETROIT MI
48202-3026
US

IV. Provider business mailing address

24143 FARMINGTON RD
FARMINGTON MI
48336-2329
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-3751
  • Fax:
Mailing address:
  • Phone: 586-770-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5601005162
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301500667
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: