Healthcare Provider Details

I. General information

NPI: 1275696908
Provider Name (Legal Business Name): GARY ALAN WASIAK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2997 E HIGHLAND RD
HIGHLAND MI
48356-2811
US

IV. Provider business mailing address

2997 E HIGHLAND RD
HIGHLAND MI
48356-2811
US

V. Phone/Fax

Practice location:
  • Phone: 248-887-3729
  • Fax: 248-889-8910
Mailing address:
  • Phone: 248-887-3729
  • Fax: 248-889-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000651
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901000651
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: