Mark Lloyd Wisniewski, M.D.

Primary specialty

Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X

License

7134A Issued in WY

Practice address

1307 W 3Rd St
#B
Gillette, WY 82716-3343

Phone

(801) 707-1874

NPI assigned

Dec 26, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Page Hospital

  • Critical Access Hospital
  • Page, AZ
  • NPI 1578515789
  NPD (past)
• Riverwoods Anesthesia PLLC

  • Anesthesiology Physician
  • Provo, UT
  • NPI 1821290883
  NPD (past)

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421280000000",
    "number": "1669537072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 W 3RD ST",
            "address_2": "#B",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163343",
            "telephone_number": "801-707-1874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 W 3RD ST",
            "address_2": "#B",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163343",
            "telephone_number": "801-707-1874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNIEWSKI",
        "first_name": "MARK",
        "middle_name": "LLOYD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2015-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "WY",
            "license": "7134A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moriahn Wilson, PA-C
• Ragen Wilson, PT
• Amy Rebecca Winkleman, D.P.M.
• Candace M Winters, PA
• Wise Counseling, LLC
• Wojciech Zolcik, M.D., P.C.
• Rickay Marie Wolf, APRN, PMHNP-BC
• Womens Healthcare PC
• Wonderfully Well LLC
• Danielle Wood, EMT

• Pediatric Anesthesiology Physician in Gillette, WY
• Providers in Gillette, WY by specialty
• Pediatric Anesthesiology Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; 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.