DEBORAH BANAZAK WAGENAAR (NPI# 1255315628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255315628 |
| Entity Type | Individual |
| Full Name | DEBORAH BANAZAK WAGENAAR |
| Other Name | DEBORAH ANNE BANAZAK |
| Credential | D.O. |
| Practice Address |
909 Fee Rd Room B119 Michigan State University Department of Psychiatry East Lansing MI 48824-3603 |
| Mailing Address |
965 Fee Rd Room A239 Michigan State University Department of Psychiatry East Lansing MI 48824-2893 |
| Practice Telephone | 5173533070 |
| Practice Fax Number | 5174323603 |
| Mailing Telephone | 5173533070 |
| Mailing Fax Number | 5174323603 |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2016-06-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
5101008530 | MI | Allopathic & Osteopathic Physicians |
| Y | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
5101008530 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1255315628 | 05 | |
| MI | 3179331 | 05 |
| Street Address |
909 FEE RD ROOM B119 MICHIGAN STATE UNIVERSITY DEPARTMENT OF PSYCHIATRY |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-3603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861609992 | Alyse F Ley | Psychiatry & Neurology | 909 Fee Rd Room B119, East Lansing, MI 48824-3603 | 2007-05-17 |
| 1952337545 | Michigan State University Dept of Psychiatry | Psychiatry & Neurology | 909 Fee Rd Room B119, East Lansing, MI 48824-6549 | 2006-06-24 |
| 1083698930 | Christine Larsen Shafer | Psychiatry & Neurology | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-12-05 |
| 1518941574 | Dianne Seaver Singleton | Psychologist | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-12-02 |
| 1962486928 | Christopher Paul Giuliano | Psychologist | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-12-02 |
| 1013991470 | Albert Stanley Aniskiewicz | Clinical Neuropsychologist | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-1315 | 2005-11-30 |
| 1619951936 | Jed Gary Magen | Psychiatry & Neurology | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 2084P0805X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Geriatric Psychiatry |
| Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598007007 | Maria Il-cha Choe | Psychiatry & Neurology | 3656 Creekside Dr, Ann Arbor, MI 48105-9308 | 2013-03-22 |
| 1154682656 | Geropsych-at-home | Psychiatry & Neurology | 1267 Lone Pine Rd, Bloomfield Hills, MI 48302-2820 | 2012-06-01 |
| 1306143235 | Geropsych Group LLC | Psychiatry & Neurology | 32270 Telegraph Rd Ste 240, Bingham Farms, MI 48025-2457 | 2011-02-11 |
| 1891025870 | Commerce Township Psychiatry,pllc | Psychiatry & Neurology | 6021 Carroll Lake Rd, Commerce Township, MI 48382-3136 | 2010-01-13 |
| 1215158472 | Stephen Michael Aronson | Psychiatry & Neurology | 2020 Hogback Officenter, Ann Arbor, MI 48105 | 2007-05-02 |
| 1841315231 | Soon Kuyn Kim | Psychiatry & Neurology | 29433 Southfield Rd, Suite 201, Southfield, MI 48076-2031 | 2007-03-21 |
| 1114092939 | Paul J Sorgi | Psychiatry & Neurology | 616 Petoskey St Ste 110, Petoskey, MI 49770-2779 | 2006-11-21 |
| 1578580411 | Fernando Castro-urrutia | Psychiatry & Neurology | 259 E Chicago St, Coldwater, MI 49036-2046 | 2006-07-16 |
| 1336188101 | Rd Senior Care Services PC | Psychiatry & Neurology | 1157 Union Lake Rd, White Lake, MI 48386-4348 | 2006-06-06 |
| 1306224621 | Sarah Myer | Psychiatry & Neurology | 5500 Armstrong Rd, Battle Creek, MI 49037-7314 | 2015-05-07 |
| Find all providers with the same taxonomy | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
Please comment or provide details below to improve the information on DEBORAH BANAZAK WAGENAAR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.