Individual
DR. STANLEY WALTER WISNIOSKI III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10887 N MILITARY TRL STE 5, PALM BEACH GARDENS, FL 33410-6528
(561) 324-9600
(561) 799-9980
Mailing address
10887 N MILITARY TRL STE 5, PALM BEACH GARDENS, FL 33410-6528
(561) 324-9600
(561) 779-9980
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
OS9152
FL
207Q00000X
Family Medicine Physician
OS9152
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52028
BLUE CROSS BLUE SHIELD ID
FL
01
—
K6281
MEDICARE GROUP ID
FL
01
—
OS9152
MEDICAL LICENSE NUMBER
FL
01
—
U3317Z
MEDICARE SIFFIX
FL
Enumeration date
11/03/2006
Last updated
11/16/2020
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