Wally S. Mahar, M.D. P.L.L.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301030215 Issued in MI

Legal business name

WALLY S. MAHAR, M.D. P.L.L.C.

Practice address

21 Midland St
Highland Park, MI 48203-3727

Phone

(586) 556-1997

Fax

(313) 731-7025

NPI assigned

Mar 15, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wally Sherman Mahar, M.D.NPI 1790730497

Title

C.E.O Chairman of the Board of Dire

Phone

(586) 556-1997

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wally Sherman Mahar, M.D.

  • General Practice Physician
  • Highland Park, MI
  • NPI 1790730497
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1578862645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 MIDLAND ST",
            "city": "HIGHLAND PARK",
            "state": "MI",
            "postal_code": "482033727",
            "telephone_number": "586-556-1997",
            "fax_number": "313-731-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MIDLAND ST",
            "city": "HIGHLAND PARK",
            "state": "MI",
            "postal_code": "482033727",
            "telephone_number": "586-556-1997",
            "fax_number": "313-731-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLY S. MAHAR, M.D. P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-15",
        "last_updated": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "MAHAR",
        "authorized_official_first_name": "WALLY",
        "authorized_official_middle_name": "SHERMAN",
        "authorized_official_title_or_position": "C.E.O CHAIRMAN OF THE BOARD OF DIRE",
        "authorized_official_telephone_number": "586-556-1997",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301030215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4301030215",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarice Valdry, RN
• Stephanie Vieira
• Jeanett Villagomezde Muir, MSW
• Visions House
• Vivent Pharmacy Michigan LLC (Vivent Pharmacy)
• Keith Walton, FAODP
• Aliya Deshaun Washington
• David Watkins
• Catrina Weaver
• Janice Wedlow

• Family Medicine Physician in Highland Park, MI
• Providers in Highland Park, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.