Provider Demographics
NPI:1821057159
Name:WASILEWSKI, ALICJA DORATA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICJA
Middle Name:DORATA
Last Name:WASILEWSKI
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1332 BALFOUR ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1022
Mailing Address - Country:US
Mailing Address - Phone:313-640-7918
Mailing Address - Fax:
Practice Address - Street 1:2314 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3045
Practice Address - Country:US
Practice Address - Phone:313-562-6633
Practice Address - Fax:313-562-0880
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI53150050372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI260H218870OtherBLUE CROSS BLUE SHIELD