Healthcare Provider Details

I. General information

NPI: 1093699571
Provider Name (Legal Business Name): WAS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22525 HALL RD
MACOMB MI
48042-5265
US

IV. Provider business mailing address

22525 HALL RD
MACOMB MI
48042-5265
US

V. Phone/Fax

Practice location:
  • Phone: 313-319-9802
  • Fax: 313-319-9802
Mailing address:
  • Phone: 313-319-9802
  • Fax: 313-319-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM STEFANI
Title or Position: PRESIDENT
Credential:
Phone: 313-319-9802