Active NPI
Charles John Gwizdala, M.D.
- Pulmonary Disease Physician
- Traverse City, MI
National Provider Identifier
1326045840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 4301051700
- Practice address
- 5087 N Royal Dr
Traverse City, MI 49684-6987 - Phone
- (231) 935-0440
- Fax
- (231) 935-0445
- NPI assigned
- Jun 30, 2005
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | 4301051700 | MI | |
| Sleep Medicine (Internal Medicine) Physician | 207RS0012X | 4301051700 | MI | |
| Pulmonary Disease Physician | 207RP1001X | 4301051700 | MI | Primary |
Addresses
Primary practice location
5087 N Royal Dr
Traverse City, MI 49684-6987
Mailing address
5087 N Royal Dr
Traverse City, MI 49684-6987
Phone (231) 935-0440
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0B81008 | Other | MI | BCBS |
| 290008345 | Other | MI | RAILROAD MEDICARE |
| 3307861 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571011200000",
"number": "1326045840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5087 N ROYAL DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496846987",
"telephone_number": "231-935-0440",
"fax_number": "231-935-0445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5087 N ROYAL DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496846987",
"telephone_number": "231-935-0440",
"fax_number": "231-935-0445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWIZDALA",
"first_name": "CHARLES",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2019-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "MI",
"license": "4301051700",
"primary": false
},
{
"code": "207RS0012X",
"taxonomy_group": "",
"desc": "Internal Medicine, Sleep Medicine",
"state": "MI",
"license": "4301051700",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "MI",
"license": "4301051700",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0B81008",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "290008345",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3307861",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.