Provider Demographics
NPI:1194031062
Name:WEDES, SAMUEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:H
Last Name:WEDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:36475 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-655-5438
Mailing Address - Fax:734-655-4287
Practice Address - Street 1:36475 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-5438
Practice Address - Fax:734-655-4287
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43011044662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301104466OtherSTATE OF MICHIGAN