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General NPI Number Information
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NPI Number | 1952417065
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Entity Type | Organization
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Legal Business Name | STUART WILLNER DO PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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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
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Country | US
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Telephone | 248-889-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 353 NORTH DRIVE
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City | WYANDOTTE
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State | MI
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Zip | 48192
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Country | US
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Telephone | 734-285-3057
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Fax | 734-285-3057
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Authorized Official
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Title or Position | BILLER
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Name | MRS. BARBARA R IRVINE
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Credential |
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Telephone | 734-285-3057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5101005829
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License Number State | MI
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