Wizenberg, Theodore A

Wizenberg, Theodore A is an sole proprietor health care provider with primary practice located at 23901 Lahser Rd , Southfield MI 48034-6035. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wizenberg, Theodore A can be contacted via phone (248) 357-3360.

Contact Information

Primary practice address
23901 Lahser Rd Southfield MI 48034-6035
Phone: (248) 357-3360
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 4301038081 Michigan

Profile Details

NPI number 1932102423
LBN Legal business name Wizenberg, Theodore A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 27th, 2005
Last updated Oct 23rd, 2007 - about 17 years ago

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 1932102423 NPPES
Michigan Other 1106338231 BCBS

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