Provider Demographics
NPI:1447471669
Name:WENDY W. WEBSTER DPM,PC
Entity type:Organization
Organization Name:WENDY W. WEBSTER DPM,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:313-864-0740
Mailing Address - Street 1:19207 SCHAEFER HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1273
Mailing Address - Country:US
Mailing Address - Phone:313-864-0740
Mailing Address - Fax:313-864-0741
Practice Address - Street 1:19933 LIVERNOIS AVE
Practice Address - Street 2:STE B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1234
Practice Address - Country:US
Practice Address - Phone:313-864-0740
Practice Address - Fax:313-864-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5825263OtherBLUECROSS BLUESHIELD
MI5901001956OtherSTATE LICENSE NUMBER
MI134271084Medicaid
MI5901001956OtherSTATE LICENSE NUMBER
MIU81060Medicare UPIN
MI5901001956OtherSTATE LICENSE NUMBER
MI0N12580Medicare PIN