Active NPI
Theodore A Wizenberg, M.D.
- Internal Medicine Physician
- Southfield, MI
National Provider Identifier
1932102423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301038081
- Practice address
- 23901 Lahser Rd
Southfield, MI 48034-6035 - Phone
- (248) 357-3360
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301038081 | MI | Primary |
Addresses
Primary practice location
23901 Lahser Rd
Southfield, MI 48034-6035
Mailing address
31151 Westwood Rd
Farmington Hills, MI 48331-1471
Phone (248) 661-9125
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1106338231 | Other | MI | BCBS |
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 |
|---|---|---|---|
| 2 | MI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 4301038081 | MI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193097600000",
"number": "1932102423",
"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": "480346035",
"telephone_number": "248-357-3360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIZENBERG",
"first_name": "THEODORE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-27",
"last_updated": "2007-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301038081",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1106338231",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- 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.