Active NPI
Jonathan Edward Wiese, M.D.
- Emergency Medicine Physician
- Milwaukee, WI
National Provider Identifier
1689994113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 56819-20
- Practice address
- 9200 W Wisconsin Ave
Milwaukee, WI 53226 - Phone
- (414) 805-6450
- Fax
- (414) 805-6464
- NPI assigned
- Jun 7, 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 56819-20 | WI | Primary |
Addresses
Primary practice location
9200 W Wisconsin Ave
Milwaukee, WI 53226
Mailing address
9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 805-6450
Other practice location 1
4805 S Moorland Rd
New Berlin, WI 53151-7401
Phone (414) 805-6450
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689994113 | Medicaid | WI |
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 |
|---|---|---|---|
| 56819-20 | WI | MD | Emergency Medicine Physician |
Interoperability endpoints
- jwiesemd256115@direct.froedtert.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701302400000",
"number": "1689994113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263522",
"telephone_number": "414-805-6450",
"fax_number": "414-805-6464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9200 W WISCONSIN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53226",
"telephone_number": "414-805-6450",
"fax_number": "414-805-6464"
}
],
"practiceLocations": [
{
"address_1": "4805 S Moorland Rd",
"address_purpose": "LOCATION",
"city": "New Berlin",
"state": "WI",
"postal_code": "531517401",
"country_code": "US",
"telephone_number": "414-805-6450",
"fax_number": "414-805-6464",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIESE",
"first_name": "JONATHAN",
"middle_name": "EDWARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-07",
"last_updated": "2023-11-30",
"certification_date": "2023-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WI",
"license": "56819-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1689994113",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.