MEDICARE: WATZMAN CONSULTING PARTNERS

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	640006672	MI

General Provider Information

NPI Number	:	1487163804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATZMAN CONSULTING PARTNERS

Provider Business Mailing Address
First Line	:	3173 TUCKAHOE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-2447
Country	:	US
Telephone Number	:	248-342-4276
Fax Number	:

Provider Business Practice Location Address
First Line	:	36800 WOODWARD AVE
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0915
Country	:	US
Telephone Number	:	248-342-4276
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY WATZMAN
Credential	:	DDS
Telephone Number	:	248-342-4276

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	09/28/2017

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