Provider Demographics
NPI:1851558787
Name:PETER M WILUSZ DPM PC
Entity Type:Organization
Organization Name:PETER M WILUSZ DPM PC
Other - Org Name:TOWN CENTER FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-681-8187
Mailing Address - Street 1:6510 TOWN CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4822
Mailing Address - Country:US
Mailing Address - Phone:248-922-6000
Mailing Address - Fax:248-922-5996
Practice Address - Street 1:6510 TOWN CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4822
Practice Address - Country:US
Practice Address - Phone:248-922-6000
Practice Address - Fax:248-922-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPW002033213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty