Individual
MARY ANN WAKE UZNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
18101 E WARREN AVE, DETROIT, MI 48224-1382
(313) 881-5678
Mailing address
1 ROSE TERRACE ST, GROSSE POINTE FARMS, MI 48236-3718
(313) 884-3434
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5501000979
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00949600022
—
MI
01
—
30392
BLUE CROSS BLUE SHIELD
MI
Enumeration date
04/16/2007
Last updated
07/08/2007
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