Dwight Fiske, PA-C, RN, AEMT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601003088 Issued in MI

Practice address

200 Hemlock St
Tawas City, MI 48763-9237

Phone

(989) 362-3411

Fax

(989) 362-9925

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant, Registered Nurse

State licenses

Practice roles

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.

• Northern Michigan Emergency Physicians, LLP

  • Emergency Medicine Physician
  • West Branch, MI
  • NPI 1528083292

  Physician Assistant

  NPD (past)
• Advanced Pediatric Specialists LLC

  • Pediatrics Physician
  • Savannah, GA
  • NPI 1073046397
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1669499133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 W 1ST ST",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487639688",
            "telephone_number": "989-820-8127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEMLOCK ST",
            "city": "TAWAS CITY",
            "state": "MI",
            "postal_code": "487639237",
            "telephone_number": "989-362-3411",
            "fax_number": "989-362-9925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISKE",
        "first_name": "DWIGHT",
        "credential": "PA-C, RN, AEMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "542502590A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01147225",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "542502590B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glen Enzenberger, DO
• Ryan Thomas Fahy, DO
• Family Foot and Ankle Center, P.C.
• Nicole Farrand, OTRL
• Mary Anne Filka, RN
• FMG North Street West Michigan LLC
• Chelsea Gabrielle Fournier, LPTA
• Geri Lyn Fowler, RN, QIDP, QMHP
• Mark A Gallagher, D.O.
• Cathleen M Garner

• Physician Assistant in Tawas City, MI
• Providers in Tawas City, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.