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Organization
THEODORE A. WIZENBERG, M.D.,P.C.
Active
Organization
THEODORE A. WIZENBERG, M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE A WIZENBERG M.D. (PRESIDENT)
(248) 661-9125
Entity
Organization
Contact information
Practice address
23901 LAHSER RD, SOUTHFIELD, MI 48033-6035
(248) 357-3360
Mailing address
31151 WESTWOOD RD, FARMINGTON HILLS, MI 48331-1471
(248) 661-9125
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
TW038081
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106338231
BCBS
MI
01
—
113381
CARE CHOICE
MI
01
—
200089
TOTAL HEALTH
MI
01
—
A77757
HAP
MI
Enumeration date
05/23/2006
Last updated
10/23/2007
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