Active NPI
Michael Sullivan Wiederhold, M.D., M.P.H., M.S.
- Pediatrics Physician
- Altamonte Springs, FL
National Provider Identifier
1013137694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME0111708
- Practice address
- 900 Hope Way
Altamonte Springs, FL 32714-1502 - Phone
- (407) 357-1000
- NPI assigned
- Apr 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME0111708 | FL | Primary |
| Pediatrics Physician | 208000000X | E-6152 | AR |
Addresses
Primary practice location
900 Hope Way
Altamonte Springs, FL 32714-1502
Mailing address
900 Hope Way
Altamonte Springs, FL 32714-1502
Phone (407) 357-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-6152 | AR | MD | Pediatrics Physician |
| ME0111708 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461801600000",
"number": "1013137694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 HOPE WAY",
"city": "ALTAMONTE SPRINGS",
"state": "FL",
"postal_code": "327141502",
"telephone_number": "407-357-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 HOPE WAY",
"city": "ALTAMONTE SPRINGS",
"state": "FL",
"postal_code": "327141502",
"telephone_number": "407-357-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDERHOLD",
"first_name": "MICHAEL",
"middle_name": "SULLIVAN",
"name_prefix": "Dr.",
"credential": "M.D., M.P.H., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-26",
"last_updated": "2016-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME0111708",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AR",
"license": "E-6152",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altamonte Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.