Active NPI
Michael L Wage, MD, PHD
- Ophthalmology Physician
- Appleton, WI
National Provider Identifier
1962497370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 25737
- Practice address
- 1411 N Briarcliff Dr
Appleton, WI 54915-2842 - Phone
- (920) 730-0160
- NPI assigned
- Sep 13, 2005
- 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 | 25737 | WI | Primary |
Addresses
Primary practice location
1411 N Briarcliff Dr
Appleton, WI 54915-2842
Mailing address
1411 N Briarcliff Dr
Appleton, WI 54915-2842
Phone (920) 730-0160
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31577700 | 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)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25737 | WI | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308528000000",
"number": "1962497370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 N BRIARCLIFF DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549152842",
"telephone_number": "920-730-0160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 N BRIARCLIFF DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549152842",
"telephone_number": "920-730-0160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGE",
"first_name": "MICHAEL",
"middle_name": "L",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-13",
"last_updated": "2011-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WI",
"license": "25737",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31577700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.