Active NPI
Dudley Eugene Wiley, M.D.
- Neurology Physician
- Caledonia, MI
National Provider Identifier
1447217260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 4301035095
- Practice address
- 6968 Pines LN SE
Caledonia, MI 49316-9095 - Phone
- (616) 891-9601
- NPI assigned
- Apr 26, 2006
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 4301035095 | MI | Primary |
Addresses
Primary practice location
6968 Pines LN SE
Caledonia, MI 49316-9095
Mailing address
6968 Pines LN SE
Caledonia, MI 49316-9095
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447217260 | Medicaid | MI | |
| 1220582 | Medicaid | MI | |
| DW035095 | Other | MI | BCBS MI STATE LIC NUMBER |
| 350D176500 | Other | MI | BCBS GROUP |
| 130D113740 | Other | MI | BCBS OF MI GROUP NUMBER |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neurological Associates of West Mi, PC | Neurology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Neurology Physician
- Grand Rapids, MI
- NPI 1295792026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491177600000",
"number": "1447217260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6968 PINES LN SE",
"city": "CALEDONIA",
"state": "MI",
"postal_code": "493169095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6968 PINES LN SE",
"city": "CALEDONIA",
"state": "MI",
"postal_code": "493169095",
"telephone_number": "616-891-9601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILEY",
"first_name": "DUDLEY",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2017-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "4301035095",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1447217260",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1220582",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MI STATE LIC NUMBER",
"identifier": "DW035095",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP",
"identifier": "350D176500",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MI GROUP NUMBER",
"identifier": "130D113740",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caledonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.