Active NPI
Marvin Wiener, M.D.
- Family Medicine Physician
- Shorewood, WI
National Provider Identifier
1013175801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 19576
- Practice address
- 2021 E Wood PL
Shorewood, WI 53211-2015 - Phone
- (414) 962-7922
- NPI assigned
- May 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 19576 | WI | Primary |
Addresses
Primary practice location
2021 E Wood PL
Shorewood, WI 53211-2015
Mailing address
2021 E Wood PL
Shorewood, WI 53211-2015
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19576 | WI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211932800000",
"number": "1013175801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2021 E WOOD PL",
"city": "SHOREWOOD",
"state": "WI",
"postal_code": "532112015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 E WOOD PL",
"city": "SHOREWOOD",
"state": "WI",
"postal_code": "532112015",
"telephone_number": "414-962-7922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIENER",
"first_name": "MARVIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-28",
"last_updated": "2008-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "19576",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.