Healthcare Provider Details

I. General information

NPI: 1124222161
Provider Name (Legal Business Name): JAMI A. WICHERT M.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 HASLETT RD STE 1
HASLETT MI
48840-8691
US

IV. Provider business mailing address

1640 HASLETT RD STE 1
HASLETT MI
48840-8691
US

V. Phone/Fax

Practice location:
  • Phone: 517-575-0501
  • Fax: 517-575-0503
Mailing address:
  • Phone: 517-575-0501
  • Fax: 517-575-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301070653
License Number StateMI

VIII. Authorized Official

Name: JAMI A WICHERT
Title or Position: OWNER
Credential: M.D.
Phone: 517-575-0501