Provider Demographics
NPI:1174588370
Name:WANDZEL, RICHARD A (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:WANDZEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4504
Mailing Address - Country:US
Mailing Address - Phone:248-889-7600
Mailing Address - Fax:248-889-5876
Practice Address - Street 1:222 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4504
Practice Address - Country:US
Practice Address - Phone:248-889-7600
Practice Address - Fax:248-889-5876
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI008319207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00689226OtherMEDICARE RAILROAD RETIREMENT
MI1751002Medicaid
MIP00689226OtherMEDICARE RAILROAD RETIREMENT