Healthcare Provider Details

I. General information

NPI: 1952383150
Provider Name (Legal Business Name): HARRY J WASVARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CROOKS RD
ROYAL OAK MI
48067-1301
US

IV. Provider business mailing address

1121 CROOKS RD
ROYAL OAK MI
48067-1301
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-8554
  • Fax: 248-541-1791
Mailing address:
  • Phone: 248-541-8554
  • Fax: 248-541-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301059778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: