Steven John Wisniewski
Internist Geriatric Medicine
829 N Center Ave Suite 140
Gaylord
, Michigan 49735-1595
Steven John Wisniewski
Internist Geriatric Medicine
829 N Center Ave Suite 140
Gaylord
, Michigan 49735-1595
(989) 731-7929
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About
Features
Specialties
- Internist
- Geriatric Medicine
Languages spoken
- English
Location
First Address
- Steven John Wisniewski
- 271 Mccoy Rd W
- Gaylord, MI
- Zip : 49735-8253
- Fax : (989) 731-7929
- Phone : (989) 731-7708
Second Address
- Steven John Wisniewski
- 829 N Center Ave Suite 140
- Gaylord, MI
- Zip : 49735-1595
- Fax : (989) 731-7837
- Phone : (989) 731-7870
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Is Steven John Wisniewski a sole practitioner?
Is Steven John Wisniewski accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207R00000X | Internist | 4301050548 | MI |
| Y | 111NI0900X | Internist | 4301050548 | MI |
| N | 207RG0300X | Geriatric Medicine | 430150548 | MI |
National Provider Identifier
| NPI | 1104851658 |
|---|---|
| Provider Name | Steven John Wisniewski |
| First Address | Gaylord, MI 49735-8253 |
| Second Address | Gaylord, MI 49735-1595 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/07/2006 |
| Last Update Date | 19/06/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0F96004016 | MEDICARE PTAN (01) | MI |
| 1101507782 | BCBSM PROVIDER NUMBER (01) | MI |
| 11292239 | CAQH PROVIDER ID (01) | |
| 381303843 | TAX ID (01) | |
| 4619513 | (05) | MI |
| B44110 | (02) | |
| CC4805 | MEDICARE RR PROV ID (01) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.