Provider Demographics
NPI:1083647739
Name:PETER M WILUSZ DPM PC
Entity Type:Organization
Organization Name:PETER M WILUSZ DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-672-8805
Mailing Address - Street 1:5730 BELLA ROSA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4774
Mailing Address - Country:US
Mailing Address - Phone:248-922-6000
Mailing Address - Fax:248-922-5779
Practice Address - Street 1:5730 BELLA ROSA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348
Practice Address - Country:US
Practice Address - Phone:248-922-6000
Practice Address - Fax:248-922-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002033213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5790397OtherCIGNA
MI7210519OtherAETNA
MIQMXPR0030596OtherMOLINA HEALTH CARE
162339OtherGLHP
MIU93968OtherHAP
MI4940030 TYPE 13Medicaid
MI71863OtherOMNICARE
MI00002528538OtherUNITED HEALTHCARE
MI5790397OtherCIGNA
MI4940030 TYPE 13Medicaid
MIU93968OtherHAP