Individual
BRIAN G WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1414 W FAIR AVE, SUITE 36, MARQUETTE, MI 49855-2675
(906) 225-3867
(906) 225-7667
Mailing address
4602 DEPT, CAROL STREAM, IL 60122-0021
(906) 225-3867
(906) 225-7667
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301068433
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0805211261
BCBSM
MI
Enumeration date
05/19/2006
Last updated
04/22/2009
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