MEDICARE: SUZANNE WOLTANSKI MD

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	208000000X	Pediatrics Physician	4301059819	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205889920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE WOLTANSKI MD

Provider Business Mailing Address
First Line	:	29130 RIVERBANK ST
Second Line	:
City	:	HARRISON TWP
State	:	MI
Zip	:	48045-1633
Country	:	US
Telephone Number	:	586-463-7432
Fax Number	:

Provider Business Practice Location Address
First Line	:	13355 E 10 MILE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-2048
Country	:	US
Telephone Number	:	586-759-7510
Fax Number	:	586-759-7791

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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