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NPI Code Detail

MEDICARE: MARY ANN WAKE UZNIS P.T.

MEDICARE: MARY ANN WAKE UZNIS P.T.
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
1174400000XSpecialist5501000979MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
130392OTHERMIBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871718841
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANN WAKE UZNIS P.T.
Provider Business Mailing Address
First Line : 1 ROSE TERRACE ST
Second Line :
City : GROSSE POINTE FARMS
State : MI
Zip : 48236-3718
Country : US
Telephone Number : 313-884-3434
Fax Number :
Provider Business Practice Location Address
First Line : 18101 E WARREN AVE
Second Line :
City : DETROIT
State : MI
Zip : 48224-1382
Country : US
Telephone Number : 313-881-5678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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Directions to “ MARY ANN WAKE UZNIS P.T.” Practice Location

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