| James P. Wiaduck, M.d. | |
|
4461 Grand Haven Road Muskegon MI 49441 | |
| (231) 798-8337 | |
| (231) 798-9816 |
| Full Name | James P. Wiaduck, M.d. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4461 Grand Haven Road, Muskegon, Michigan |
| Authorized Official Name and Position | James Patrick Wiaduck (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2317988337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James P. Wiaduck, M.d. P.o. Box 334 Grand Haven MI 49417 Ph: (231) 798-8337 | James P. Wiaduck, M.d. 4461 Grand Haven Road Muskegon MI 49441 Ph: (231) 798-8337 |
| NPI Number | 1982824512 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 01/08/2020 |
| Certification Date | 01/08/2020 |
| Medicare PECOS PAC ID | 4688771728 |
|---|---|
| Medicare Enrollment ID | O20070524000047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982824512 | NPI | - | NPPES |
| PTANON10230 | Other | MI | PTAN ON10230 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0015X | Psychiatry & Neurology - Psychosomatic Medicine | 4301066579 (Michigan) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 4301066579 (Michigan) | Primary |
| Provider Name | James P Wiaduck |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114946506 PECOS PAC ID: 4789781824 Enrollment ID: I20070524000036 |
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