Provider Demographics
NPI:1548310626
Name:MATERNAL FETAL MEDICINE, PC
Entity type:Organization
Organization Name:MATERNAL FETAL MEDICINE, 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 1:800 COOPER AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5394
Mailing Address - Country:US
Mailing Address - Phone:989-755-4515
Mailing Address - Fax:989-755-4516
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:48602-5394
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:2007-01-11
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDW047758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI451216010Medicaid
MI1607310061OtherBCN
MI1607310051OtherBCN
MI450504910Medicaid
MIA78395Medicare UPIN
MIE69033Medicare UPIN
MI1607310061OtherBCN
MI450504910Medicaid