NPIMap

Individual provider Active NPI

Lucas John Wyzlic, P.A.

  • Physician Assistant
  • West Branch, MI
National Provider Identifier
1760731012
Registry record updated Aug 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006424 Issued in MI
Practice address
621 Court Street
Suite 104
West Branch, MI 48661
Phone
(989) 701-2293
NPI assigned
Aug 31, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601006424 MI Primary

Addresses

Primary practice location

621 Court Street
Suite 104
West Branch, MI 48661

Mailing address

4238 Lakeside Drive
West Branch, MI 48661
Phone (775) 315-1022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121031000294 MI Practitioner - Physician Assistant 2567612450 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Ironwood Hospital and Clinics IncGroup PAC ID 9032013198, 165 clinicians

Practice addresses (Care Compare)

N10561 Grandview LN
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10561 Granview LN
Grand View Hospital
Ironwood, MI 49938-9622
Phone (906) 932-2525

N10565 Grand View Lane
Ironwood, MI 49938-9622

N10565 Grandview Lane
Ironwood, MI 49938-9622

N10565 Grandview LN Aspirus Ironwood
Aspirus Palliative Medicine Michi
Ironwood, MI 49938-9622
Phone (715) 843-1067

Hospital & facility affiliations

  • Aspirus Ironwood Hospital Hospital, Ironwood, MI, CCN 231333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince Jun 6, 2013 Accepting new patients
Michigan Emergency Physicians LLP Physician Assistant CurrentSince May 18, 2013 Accepting new patients
Aspirus Keweenaw CurrentSince Feb 1, 2026 Accepting new patients
Aspirus Keweenaw CurrentSince Feb 1, 2026 Accepting new patients
Aspirus Keweenaw CurrentSince Feb 1, 2026 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

75 Remit Dr
Ste 6895
Chicago, IL 60675

168 S Howell St
Hillsdale, MI 49242
Phone (517) 437-4451

1000 Cedar St
Houghton, MI 49931
Phone (906) 482-8201

N10561 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

N10565 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

205 Osceola St
Laurium, MI 49913
Phone (906) 337-3100

Interoperability endpoints

  • Direct secure messaging: lwyzlic63768@direct.aspirus.org

Organizations & group practices 10

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346371200000",
    "number": "1760731012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4238 LAKESIDE DRIVE",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "48661",
            "telephone_number": "775-315-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 COURT STREET",
            "address_2": "SUITE 104",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "48661",
            "telephone_number": "989-701-2293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYZLIC",
        "first_name": "LUCAS",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-31",
        "last_updated": "2012-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Branch, MI

Sources for this page

Verify at the official NPI Registry.