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General NPI Number Information
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NPI Number | 1225280407
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Entity Type | Organization
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Legal Business Name | RICHARD A. WANDZEL, DO PC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 222 W HIGHLAND RD
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City | HIGHLAND
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State | MI
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Zip | 48357-4504
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Country | US
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Telephone | 248-889-7600
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Fax | 248-889-5876
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Provider Business Mailing Address
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Address Line | 222 W HIGHLAND RD
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City | HIGHLAND
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State | MI
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Zip | 48357-4504
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Country | US
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Telephone | 248-889-7600
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Fax | 248-889-5876
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD A WANDZEL
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Credential | D.O.
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Telephone | 248-889-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 5101008319
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License Number State | MI
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