Provider Demographics
NPI:1952417065
Name:STUART WILLNER DO PC
Entity Type:Organization
Organization Name:STUART WILLNER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-285-3057
Mailing Address - Street 1:353 NORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192
Mailing Address - Country:US
Mailing Address - Phone:734-285-3057
Mailing Address - Fax:734-285-3057
Practice Address - Street 1:222 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357
Practice Address - Country:US
Practice Address - Phone:248-889-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005829207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0558226125OtherBC BS OF MI
E26788Medicare UPIN
MI5822612Medicare ID - Type Unspecified