Provider Demographics
NPI:1639149677
Name:WAITZMAN, ARIEL ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:ANDRE
Last Name:WAITZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31700 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1234
Mailing Address - Country:US
Mailing Address - Phone:248-594-6734
Mailing Address - Fax:
Practice Address - Street 1:22731 NEWMAN STREET
Practice Address - Street 2:STE 120
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-582-8853
Practice Address - Fax:313-582-6417
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071017207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG65014Medicare UPIN
MION30280Medicare ID - Type Unspecified