Healthcare Provider Details

I. General information

NPI: 1306858824
Provider Name (Legal Business Name): MICHAEL J WERTHEIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 W CADILLAC DR
FARWELL MI
48622-9757
US

IV. Provider business mailing address

2812 W CADILLAC DR
FARWELL MI
48622-9757
US

V. Phone/Fax

Practice location:
  • Phone: 989-588-5050
  • Fax: 989-588-5052
Mailing address:
  • Phone: 989-588-5050
  • Fax: 989-588-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMW042891
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: