Active NPI
Cameron Wilde
- Sports Medicine (Emergency Medicine) Physician
- Ann Arbor, MI
National Provider Identifier
1750143863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Emergency Medicine) Physician
- License
- 2601002974
- Practice address
- 1000 S State St
Ann Arbor, MI 48109-2201 - Phone
- (734) 763-2958
- NPI assigned
- Jan 24, 2024
- 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 |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | 2601002974 | MI | Primary |
Addresses
Primary practice location
1000 S State St
Ann Arbor, MI 48109-2201
Mailing address
University of Michigan Athletics 1000 S. State St.
Ann Arbor, MI 48109
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601002974 | MI | MD | Sports Medicine (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706054400000",
"number": "1750143863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "UNIVERSITY OF MICHIGAN ATHLETICS 1000 S. STATE ST.",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 S STATE ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481092201",
"telephone_number": "734-763-2958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDE",
"first_name": "CAMERON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-24",
"last_updated": "2024-01-24",
"certification_date": "2024-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "207PS0010X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Sports Medicine",
"state": "MI",
"license": "2601002974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.