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General NPI Number Information
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NPI Number | 1548529688
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Entity Type | Individual
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Provider Name | HEATHER NICOLE WAHL MD
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Gender | Female
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 5333 MCAULEY DR RM 2110
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City | YPSILANTI
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State | MI
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Zip | 48197-1097
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Country | US
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Telephone | 734-802-5030
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Fax | 734-887-8946
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 35.133941
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301100508
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License Number State | MI
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