Provider Demographics
NPI:1144397068
Name:HILLEBRAND, WENDY ANN (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:HILLEBRAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30100 TELEGRAPH
Mailing Address - Street 2:SUITE 475
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-642-6490
Mailing Address - Fax:248-647-1472
Practice Address - Street 1:30100 TELEGRAPH
Practice Address - Street 2:SUITE 475
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-642-6490
Practice Address - Fax:248-647-1472
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0484372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2706306531OtherBLUE CROSS BLUE SHIELD
MI0630653Medicare ID - Type Unspecified
MI2706306531OtherBLUE CROSS BLUE SHIELD