Active NPI
Robert P Wahl, M.D.
- Emergency Medicine Physician
- Detroit, MI
National Provider Identifier
1245290121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 4301049741
- Practice address
- 4201 Saint Antoine St
6G-University Health Center
Detroit, MI 48201-2153 - Phone
- (313) 993-2530
- Fax
- (313) 993-7703
- NPI assigned
- Mar 24, 2006
- Last updated
- Jun 28, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 4301049741 | MI | Primary |
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 4301049741 | MI |
Addresses
Primary practice location
4201 Saint Antoine St
6G-University Health Center
Detroit, MI 48201-2153
Mailing address
4201 Saint Antoine St
6G-University Health Center
Detroit, MI 48201-2153
Phone (313) 993-2530
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RW049741 | Other | MI | BC/BS OF MI |
| 101988630 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- rwahl@direct.dmc.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277683200000",
"number": "1245290121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 SAINT ANTOINE ST",
"address_2": "6G-UNIVERSITY HEALTH CENTER",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012153",
"telephone_number": "313-993-2530",
"fax_number": "313-993-7703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 SAINT ANTOINE ST",
"address_2": "6G-UNIVERSITY HEALTH CENTER",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012153",
"telephone_number": "313-993-2530",
"fax_number": "313-993-7703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHL",
"first_name": "ROBERT",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2010-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "4301049741",
"primary": true
},
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "MI",
"license": "4301049741",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MI",
"identifier": "RW049741",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101988630",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.