Individual
DR. THOMAS POWELL WALDINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
285 N LILLEY RD, CANTON, MI 48187-3907
(734) 495-1506
(734) 829-2589
Mailing address
285 N LILLEY RD, CANTON, MI 48187-3907
(734) 495-1506
(734) 829-2589
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301043778
MI
207NS0135X
Procedural Dermatology Physician
4301043778
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P12450
MEDICARE GROUP
MI
Enumeration date
06/24/2005
Last updated
10/30/2018
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