Wagenaar, Deborah Banazak

Wagenaar, Deborah Banazak is an individual health care provider with primary practice located at 909 Wilson Rd Rm B119 , East Lansing MI 48824-6410. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Geriatric Psychiatry. Allopathic & Osteopathic Physicians / Geriatric Psychiatry is her primary health care specialty. Wagenaar, Deborah Banazak can be contacted via phone (517) 353-3070.

Contact Information

Primary practice address
909 Wilson Rd Rm B119 East Lansing MI 48824-6410
Phone: (517) 353-3070
Fax: (517) 884-1817
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 5101008530 Michigan
Allopathic & Osteopathic Physicians / Geriatric Psychiatry 2084P0805X 5101008530 Michigan

Profile Details

NPI number 1255315628
LBN Legal business name Wagenaar, Deborah Banazak
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2005
Last updated Jun 29th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255315628 NPPES
Michigan MEDICAID 1255315628
Michigan MEDICAID 3179331

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