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General NPI Number Information
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NPI Number | 1124222161
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Entity Type | Organization
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Legal Business Name | JAMI A. WICHERT M.D. PLLC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 1640 HASLETT RD STE 1
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City | HASLETT
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State | MI
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Zip | 48840-8691
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Country | US
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Telephone | 517-575-0501
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Fax | 517-575-0503
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Provider Business Mailing Address
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Address Line | 1640 HASLETT RD STE 1
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City | HASLETT
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State | MI
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Zip | 48840-8691
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Country | US
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Telephone | 517-575-0501
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Fax | 517-575-0503
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Authorized Official
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Title or Position | OWNER
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Name | JAMI A WICHERT
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Credential | M.D.
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Telephone | 517-575-0501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301070653
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License Number State | MI
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