Healthcare Provider Details

I. General information

NPI: 1487936456
Provider Name (Legal Business Name): TANYA S POSTWAITE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA WHEELER PA

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2689
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2417
  • Fax: 313-916-8416
Mailing address:
  • Phone: 313-916-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601006534
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: