Theodore a. Wizenberg, M.D.,P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

TW038081 Issued in MI

Legal business name

THEODORE A. WIZENBERG, M.D.,P.C.

Practice address

23901 Lahser Rd
Southfield, MI 48033-6035

Phone

(248) 357-3360

NPI assigned

May 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Theodore A Wizenberg, M.D.

Title

President

Phone

(248) 661-9125

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1821043399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31151 WESTWOOD RD",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483311471",
            "telephone_number": "248-661-9125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23901 LAHSER RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480336035",
            "telephone_number": "248-357-3360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE A. WIZENBERG, M.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "WIZENBERG",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-661-9125",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "TW038081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "A77757",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICE",
            "identifier": "113381",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1106338231",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TOTAL HEALTH",
            "identifier": "200089",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; 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.