Active NPI
Bruce Frederick Wilkens, PA
- Physician Assistant
- Novi, MI
National Provider Identifier
1598075616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601005889
- Practice address
- 28455 Haggerty Rd
Ste 200
Novi, MI 48377-2982 - Phone
- (248) 893-3200
- Fax
- (248) 893-2951
- NPI assigned
- Oct 8, 2010
- 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 | 5601005889 | MI | Primary |
Addresses
Primary practice location
28455 Haggerty Rd
Ste 200
Novi, MI 48377-2982
Mailing address
28455 Haggerty Rd
Ste 200
Novi, MI 48377-2982
Phone (248) 893-3200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5601005889 | Other | MI | STATE LICENSE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286496000000",
"number": "1598075616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28455 HAGGERTY RD",
"address_2": "STE 200",
"city": "NOVI",
"state": "MI",
"postal_code": "483772982",
"telephone_number": "248-893-3200",
"fax_number": "248-893-2951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28455 HAGGERTY RD",
"address_2": "STE 200",
"city": "NOVI",
"state": "MI",
"postal_code": "483772982",
"telephone_number": "248-893-3200",
"fax_number": "248-893-2951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKENS",
"first_name": "BRUCE",
"middle_name": "FREDERICK",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-08",
"last_updated": "2010-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601005889",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "5601005889",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.