Provider Demographics
NPI:1356418347
Name:WILANOWSKI, ALEKSANDRA (MD,)
Entity type:Individual
Prefix:MRS
First Name:ALEKSANDRA
Middle Name:
Last Name:WILANOWSKI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N WEST AVE STE 437
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2179
Mailing Address - Country:US
Mailing Address - Phone:517-539-9426
Mailing Address - Fax:517-796-4517
Practice Address - Street 1:1200 N WEST AVE STE 437
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2179
Practice Address - Country:US
Practice Address - Phone:517-539-9426
Practice Address - Fax:517-796-4517
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010660242084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION38830Medicare ID - Type Unspecified
MIH 10564Medicare UPIN