Provider Demographics
NPI:1205863404
Name:WENIG, PAUL E (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:WENIG
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 1:28100 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5967
Mailing Address - Country:US
Mailing Address - Phone:248-471-1549
Mailing Address - Fax:248-478-1827
Practice Address - Street 1:28100 GRAND RIVER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5967
Practice Address - Country:US
Practice Address - Phone:248-471-1549
Practice Address - Fax:248-478-1827
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005677207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI125354OtherCARE CHOICES
MIP44830OtherBLUE CROSS
MI4380700OtherAETNA
OM15100001Medicare ID - Type Unspecified
MI125354OtherCARE CHOICES