Stefanie Lyn Wise, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

4301096917 Issued in MI

Practice address

4201 Saint Antoine St
Uhc 9C
Detroit, MI 48201-2153

Phone

(313) 745-5146

Fax

(313) 966-0880

NPI assigned

Jun 30, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swise@direct.dmc.org

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.

• Medical Center Emergency Services

  • Emergency Medical Services (Emergency Medicine) Physician
  • Detroit, MI
  • NPI 1902855711
  Medicare reassignment NPD
• DMC Education & Research

  • Physician Assistant
  • Detroit, MI
  • NPI 1235444969
  NPD (past)

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277856000000",
    "number": "1528379997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 KENSINGTON AVE",
            "address_2": "APT. B",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242738",
            "telephone_number": "616-481-7965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST",
            "address_2": "UHC 9C",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-745-5146",
            "fax_number": "313-966-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "STEFANIE",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-30",
        "last_updated": "2010-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301096917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendall Anne Wirtanen, DO
• Wisdom Listens Counseling Services
• Kimberlydawn Wisdom, M.D.
• Dwight Wise
• Jacquelyn L. Wise, LLMSW
• Melissa Wiseheart
• Edward Wisniewski, PA-C
• Kimberly Wisniewski, LPC
• Mary Kathryn Wisniewski, LBSW
• Trisha Ann Wisniewski

• Emergency Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.