MEDICARE: DR. PETER MICHAEL WILUSZ DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PW002033	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4858214660	OTHER	MI	BLUE CROSS BLUSE SHIELD
2	4856315560	OTHER	MI	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083692925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MICHAEL WILUSZ DPM

Provider Business Mailing Address
First Line	:	5730 BELLA ROSA BLVD STE 200
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-4774
Country	:	US
Telephone Number	:	248-922-6000
Fax Number	:	248-922-5997

Provider Business Practice Location Address
First Line	:	5730 BELLA ROSA BLVD STE 200
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348
Country	:	US
Telephone Number	:	248-922-6000
Fax Number	:	248-922-5997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2005
Last Update Date	:	06/11/2018

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