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General NPI Number Information
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NPI Number | 1295364008
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Entity Type | Individual
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Provider Name | BRIAN WIDEMAN DO
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Gender | Male
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 5333 MCAULEY DR SUITE 109
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City | YPSILANTI
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State | MI
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Zip | 48197
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Country | US
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Telephone | 734-712-1400
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Fax | 616-267-7901
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105
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Country | US
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Telephone | 734-747-6766
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Fax | 734-222-3100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 5151014375
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 5101027876
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License Number State | MI
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