Active NPI
Michael McCormick
- Ophthalmology Physician
- Waukesha, WI
National Provider Identifier
1851659536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 15464-020
- Practice address
- 1111 Delafield St
Ste 312
Waukesha, WI 53188-3417 - Phone
- (262) 547-3352
- NPI assigned
- May 1, 2012
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 15464-020 | WI | Primary |
Addresses
Primary practice location
1111 Delafield St
Ste 312
Waukesha, WI 53188-3417
Mailing address
1111 Delafield St
Ste 312
Waukesha, WI 53188-3417
Phone (262) 547-3352
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31222700 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15464-020 | WI | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335830400000",
"number": "1851659536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 DELAFIELD ST",
"address_2": "STE 312",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883417",
"telephone_number": "262-547-3352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 DELAFIELD ST",
"address_2": "STE 312",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883417",
"telephone_number": "262-547-3352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-01",
"last_updated": "2012-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WI",
"license": "15464-020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31222700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.