Active NPI
Max V. Wisgerhof II, M.D.
- Endocrinology, Diabetes & Metabolism Physician
- Ann Arbor, MI
National Provider Identifier
1508934043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- 4301039438
- Practice address
- 24 Frank Lloyd Wright Dr
Lobby C Suite 1300
Ann Arbor, MI 48105-9484 - Phone
- (734) 647-5871
- NPI assigned
- Dec 1, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301039438 | MI | |
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 4301039438 | MI | Primary |
Addresses
Primary practice location
24 Frank Lloyd Wright Dr
Lobby C Suite 1300
Ann Arbor, MI 48105-9484
Mailing address
3621 South State Street
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MW039438 | Other | CHAMPUS-CHAMPUS | |
| MW039438 | Other | COMMERCIAL-COMMERCIAL NUMBER | |
| 140750910 | Medicaid | MI | |
| 700H262220 | Other | BLUE CROSS-BLUE CROSS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301039438 | MI | MD | Endocrinology, Diabetes & Metabolism Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412553600000",
"number": "1508934043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 SOUTH STATE STREET",
"address_2": "700 KMS PLACE",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 FRANK LLOYD WRIGHT DR",
"address_2": "LOBBY C SUITE 1300",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481059484",
"telephone_number": "734-647-5871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISGERHOF II",
"first_name": "MAX",
"middle_name": "V.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2014-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301039438",
"primary": false
},
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "MI",
"license": "4301039438",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS-CHAMPUS",
"identifier": "MW039438",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL-COMMERCIAL NUMBER",
"identifier": "MW039438",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "140750910",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS-BLUE CROSS",
"identifier": "700H262220",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.