Individual
BRIDGET WIATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3601 W 13 MILE RD, 400 FSC-PCS, ROYAL OAK, MI 48073
(248) 423-2481
Mailing address
26901 BEAUMONT BLVD, STE 3D, SOUTHFIELD, MI 48033-3849
(248) 423-2481
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301072275
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300F362420
BCBSM
MI
05
—
4685386
—
MI
Enumeration date
03/24/2006
Last updated
10/09/2022
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