Provider Demographics
NPI:1306858824
Name:WERTHEIMER, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WERTHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 W CADILLAC DR
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622-9757
Mailing Address - Country:US
Mailing Address - Phone:989-588-5050
Mailing Address - Fax:989-588-5052
Practice Address - Street 1:2812 W CADILLAC DR
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622-9757
Practice Address - Country:US
Practice Address - Phone:989-588-5050
Practice Address - Fax:989-588-5052
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMW042891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB49404Medicare UPIN