Provider Demographics
NPI:1538335351
Name:DANIEL J WECHTER MD PC
Entity type:Organization
Organization Name:DANIEL J WECHTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-755-4515
Mailing Address - Street 1:801 JOE MANN BLVD STE P-6
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8900
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:800 COOPER AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602
Practice Address - Country:US
Practice Address - Phone:989-755-4515
Practice Address - Fax:989-755-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2022-04-11
Deactivation Date:2022-03-23
Deactivation Code:
Reactivation Date:2022-04-08
Provider Licenses
StateLicense IDTaxonomies
MIDW047758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI017308502OtherHEALTH PLUS PIN
MI1607310051OtherBCN PIN
MI1538335351OtherMEDICARE TYPE 2 BILLING NUMBER
MI1538335351Medicaid
MI1607310051OtherBCBS PIN
MIA78395Medicare UPIN