Healthcare Provider Details

I. General information

NPI: 1053761569
Provider Name (Legal Business Name): HENRY WILLIAM WOIDA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W WACKERLY ST STE. 8
MIDLAND MI
48640-2769
US

IV. Provider business mailing address

4293 N HURON RD
PINCONNING MI
48650-8402
US

V. Phone/Fax

Practice location:
  • Phone: 989-486-9500
  • Fax: 989-486-9503
Mailing address:
  • Phone: 989-879-6244
  • Fax: 989-879-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: