Peter M Wilusz DPM PC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

5901002033 Issued in MI

Legal business name

PETER M WILUSZ DPM PC

Practice address

5730 Bella Rosa Blvd Ste 200
Clarkston, MI 48348

Phone

(248) 922-6000

Fax

(248) 922-5779

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Peter M Wilusz, DPMNPI 1083692925

Title

President

Phone

(248) 672-8805

Specialties & licenses 1

Addresses

Other identifiers 8

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.

• Peter Michael Wilusz, DPM

  • Podiatrist
  • Clarkston, MI
  • NPI 1083692925
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1083647739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5730 BELLA ROSA BLVD STE 200",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483484774",
            "telephone_number": "248-922-6000",
            "fax_number": "248-922-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5730 BELLA ROSA BLVD STE 200",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "48348",
            "telephone_number": "248-922-6000",
            "fax_number": "248-922-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER M WILUSZ DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "WILUSZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-672-8805",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "5901002033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5790397",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7210519",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTH CARE",
            "identifier": "QMXPR0030596",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GLHP",
            "identifier": "162339",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "U93968",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4940030 TYPE 13",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMNICARE",
            "identifier": "71863",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "00002528538",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Periodontal Specialists of Clarkston PC
• David Alan Perlman, MD
• Perry Drug Stores Inc and Subsidiaries (Rite Aid Pharmacy 04592)
• Perspectives of Troy, P.C.
• Peter G Grain, M.D., P.C.
• Peter M Wilusz DPM PC (Town Center Foot and Ankle Clinic)
• Peter Shaman, M.D., PC
• Peter W. Keelin, PH.D., F.L.P., L.L.C.
• Rebecca G Peterson
• Peyton & Davenport Inc.

• Foot & Ankle Surgery Podiatrist in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Foot & Ankle Surgery Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; 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.