Healthcare Provider Details

I. General information

NPI: 1578752119
Provider Name (Legal Business Name): NORMAN PAUL WIEST MALLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42189 ANN ARBOR RD E
PLYMOUTH MI
48170-4370
US

IV. Provider business mailing address

42189 ANN ARBOR RD E
PLYMOUTH MI
48170-4370
US

V. Phone/Fax

Practice location:
  • Phone: 734-453-5603
  • Fax: 734-453-5619
Mailing address:
  • Phone: 734-453-5603
  • Fax: 734-453-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6301012500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: