Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301062525 | MI |
Y | 208600000X | Surgeon | 4301062525 | MI |
N | 2086X0206X | Surgical Oncologist | 4301062525 | MI |
NPI | 1255319729 |
---|---|
Provider Name | Cheryl A Wesen |
First Address | Grosse Pointe Woods, MI 48236-2858 |
Second Address | Grosse Pointe Woods, MI 48236-2858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 03/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0H231320 | BLUE CROSS GROUP (01) | MI |
3475787 | (05) | MI |
4816915 | (05) | MI |
F69606 | (02) |