Provider Demographics
NPI:1619976305
Name:WECHTER, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:WECHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COOPER AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5394
Mailing Address - Country:US
Mailing Address - Phone:989-755-4515
Mailing Address - Fax:989-755-4516
Practice Address - Street 1:800 COOPER AVE
Practice Address - Street 2:STE 7
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5394
Practice Address - Country:US
Practice Address - Phone:989-755-4515
Practice Address - Fax:989-755-4516
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2014-09-22
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
MIDW047758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1607310051OtherBCBS PIN
MI1619976305Medicaid
MI0107308502OtherHEALTH PLUS PIN
MI1619976305OtherMEDICARE TYPE 1 NPI BILLING NUMBER
MI1607310051OtherBCN PIN
MI1607310051OtherBCN PIN