Provider Demographics
NPI:1972855534
Name:WASSERMAN, AVI (MD)
Entity Type:Individual
Prefix:
First Name:AVI
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2865 WALTERS WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8833
Mailing Address - Country:US
Mailing Address - Phone:734-255-7287
Mailing Address - Fax:734-769-1262
Practice Address - Street 1:2865 WALTERS WAY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8833
Practice Address - Country:US
Practice Address - Phone:734-255-7287
Practice Address - Fax:734-769-1262
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine