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Individual
STEVEN JOHN WISNIEWSKI
Active
Individual
STEVEN JOHN WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301050548
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
430150548
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F96004016
MEDICARE PTAN
MI
01
—
1101507782
BCBSM PROVIDER NUMBER
MI
01
—
11292239
CAQH PROVIDER ID
—
01
—
381303843
TAX ID
—
05
—
4619513
—
MI
01
—
CC4805
MEDICARE RR PROV ID
—
Enumeration date
07/12/2006
Last updated
06/19/2018
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