Active NPI
Jeffrey J. Wisniewski, P.A.C.
- Physician Assistant
- Alpena, MI
National Provider Identifier
1508896614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601003807
- Practice address
- 1501 W Chisholm St
Alpena, MI 49707-1401 - Phone
- (989) 356-7390
- Fax
- (989) 340-1214
- NPI assigned
- Jul 4, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601003807 | MI | Primary |
Addresses
Primary practice location
1501 W Chisholm St
Alpena, MI 49707-1401
Mailing address
1014 Sixth St
Ste. 103
Traverse City, MI 49684-2381
Phone (989) 340-1211
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601003807 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indigo Hospital Medicine - Alpena, PLC | 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.
-
- Internal Medicine Physician
- Alpena, MI
- NPI 1740411461
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406246400000",
"number": "1508896614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1014 SIXTH ST",
"address_2": "STE. 103",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842381",
"telephone_number": "989-340-1211",
"fax_number": "989-340-1214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 W CHISHOLM ST",
"city": "ALPENA",
"state": "MI",
"postal_code": "497071401",
"telephone_number": "989-356-7390",
"fax_number": "989-340-1214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISNIEWSKI",
"first_name": "JEFFREY",
"middle_name": "J.",
"credential": "P.A.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2014-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601003807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alpena, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.