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General NPI Number Information
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NPI Number | 1346433422
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Entity Type | Individual
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Provider Name | ALEXIS WAGMAN FEDERMAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 1385 E 12 MILE RD STE 100
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071
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Country | US
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Telephone | 248-399-6090
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Fax | 248-399-5282
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Provider Business Mailing Address
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Address Line | 1385 E 12 MILE RD STE 100
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2618
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Country | US
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Telephone | 248-399-6090
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Fax | 248-399-5282
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS10098
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101016164
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License Number State | MI
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