Provider Demographics
NPI:1578991295
Name:BRETT P WIATER MD PC
Entity Type:Organization
Organization Name:BRETT P WIATER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-644-3920
Mailing Address - Street 1:17877 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3127
Mailing Address - Country:US
Mailing Address - Phone:248-644-3920
Mailing Address - Fax:248-644-2569
Practice Address - Street 1:17877 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3127
Practice Address - Country:US
Practice Address - Phone:248-644-3920
Practice Address - Fax:248-644-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430110036207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty