Provider Demographics
NPI:1568725190
Name:WASS, NATHAN DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DANIEL
Last Name:WASS
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 1:6490 BLUE STAR HWY
Mailing Address - Street 2:
Mailing Address - City:SAUGATUCK
Mailing Address - State:MI
Mailing Address - Zip Code:49453-0001
Mailing Address - Country:US
Mailing Address - Phone:269-857-3208
Mailing Address - Fax:
Practice Address - Street 1:6490 BLUE STAR HWY
Practice Address - Street 2:
Practice Address - City:SAUGATUCK
Practice Address - State:MI
Practice Address - Zip Code:49453-0001
Practice Address - Country:US
Practice Address - Phone:269-857-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine