Provider Demographics
NPI:1528152196
Name:MCFALDA, WENDY L (DO)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:MCFALDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 BOW POINTE DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3198
Mailing Address - Country:US
Mailing Address - Phone:248-620-3376
Mailing Address - Fax:248-620-3379
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 215
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3198
Practice Address - Country:US
Practice Address - Phone:248-620-3376
Practice Address - Fax:248-620-3379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014699207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0756301335OtherBLUE CROSS BLUE SHIELD
MIWM014699OtherBLUE CARE NETWORK
MII17827OtherHAP
MI139701OtherCARE CHOICES
MIP14750001OtherMEDICARE PLUS BLUE
MIWM014699OtherBLUE CHOICE
MI139701OtherPREFERRED CHOICES
MI16961OtherMCARE
MI7938631OtherAETNA US HEALTHCARE
MIP00252806OtherMEDICARE RAILROAD
MII17827OtherHAP
MIP14750001Medicare PIN