# RICHARD A. WANDZEL, DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225280407
- **Authorized official:** DR. RICHARD A WANDZEL D.O. (OWNER)
- **Authorized official phone:** (248) 889-7600

## Contact information

- **Practice address:** 222 W HIGHLAND RD, HIGHLAND, MI 48357-4504
- **Practice address phone:** (248) 889-7600
- **Practice address fax:** (248) 889-5876
- **Mailing address:** 222 W HIGHLAND RD, HIGHLAND, MI 48357-4504
- **Mailing address phone:** (248) 889-7600
- **Mailing address fax:** (248) 889-5876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | 5101008319 | MI | Yes |

## Other

- **Enumeration date:** 10/21/2008
- **Last updated:** 02/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 040F370330 | BCBSM | MI |
| 01 | — | 0456301784 | BLUE CROSS | MI |
| 05 | — | 1751002 | — | MI |