Provider Demographics
NPI:1174785315
Name:WALDON INTERNAL MEDICINE
Entity type:Organization
Organization Name:WALDON INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HSIAO
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-625-8730
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2007
Mailing Address - Fax:810-743-1099
Practice Address - Street 1:5900 WALDON RD
Practice Address - Street 2:STE C
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4806
Practice Address - Country:US
Practice Address - Phone:248-625-8730
Practice Address - Fax:248-625-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty