Provider Demographics
NPI:1871686766
Name:WATERFORD FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:WATERFORD FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOELKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-666-9332
Mailing Address - Street 1:6620 HIGHLAND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1682
Mailing Address - Country:US
Mailing Address - Phone:248-666-9332
Mailing Address - Fax:248-666-0340
Practice Address - Street 1:6620 HIGHLAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-666-9332
Practice Address - Fax:248-666-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010F363130OtherBCBSM GROUP ID NUMBER
MIA73313Medicare UPIN
0F36313002Medicare ID - Type UnspecifiedWOELKE MC PIN
MI010F363130OtherBCBSM GROUP ID NUMBER
MIH74193Medicare UPIN
0F36313010Medicare ID - Type UnspecifiedMEYER MC PIN
MI0F363139011Medicare ID - Type UnspecifiedGROUP ID NUMBER
0F36313011Medicare ID - Type UnspecifiedVARGHESE MC PIN