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General NPI Number Information
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NPI Number | 1699902239
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Entity Type | Individual
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Provider Name | MICHELLE ANNETTE WIENER M.D,
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Gender | Female
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 22101 MOROSS RD ST JOHN
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City | DETROIT
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State | MI
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Zip | 48236-2148
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Country | US
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Telephone | 313-343-7378
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Fax |
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Provider Business Mailing Address
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Address Line | 12 LAKE COURT
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230
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Country | US
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Telephone | 248-943-4934
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301099850
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License Number State | MI
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