John Stanley Wichmann-Walczak, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD2647 Issued in HI

Practice address

94-837 Waipahu St
Waipahu, HI 96797-3320

Phone

(808) 671-3911

Fax

(808) 677-2720

NPI assigned

Aug 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. John Stanley Walczak Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1356333736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94-837 WAIPAHU ST",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967973320",
            "telephone_number": "808-671-3911",
            "fax_number": "808-677-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94-837 WAIPAHU ST",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967973320",
            "telephone_number": "808-671-3911",
            "fax_number": "808-677-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICHMANN-WALCZAK",
        "first_name": "JOHN",
        "middle_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "HI",
            "license": "MD2647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013771-03",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA PROVIDER NUMBER",
            "identifier": "00E001467-9",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN NUMBER",
            "identifier": "151218",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "WALCZAK",
            "middle_name": "STANLEY",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Physician in Waipahu, HI
• Providers in Waipahu, HI by specialty
• General Practice Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.