Provider Demographics
NPI:1467474288
Name:WARTEL, DAVID JACOB (PHD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JACOB
Last Name:WARTEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6346 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-626-1330
Mailing Address - Fax:248-626-9170
Practice Address - Street 1:6346 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2328
Practice Address - Country:US
Practice Address - Phone:248-626-1330
Practice Address - Fax:248-626-9170
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002990103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F34733OtherBLUE CROSS BLUE SHIELD MI
0F34733OtherBLUE CROSS BLUE SHIELD MI