Healthcare Provider Details

I. General information

NPI: 1619069549
Provider Name (Legal Business Name): WENDY W LAMBERT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 E 12 MILE ROAD
WARREN MI
48088-3671
US

IV. Provider business mailing address

13450 E 12 MILE ROAD
WARREN MI
48088-3671
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-5525
  • Fax: 586-759-4765
Mailing address:
  • Phone: 586-759-5525
  • Fax: 586-759-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberWL007476
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: