MEDICARE: DR. JEROME ANTHONY WISNIEW DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E1630	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033128053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME ANTHONY WISNIEW DPM

Provider Business Mailing Address
First Line	:	2705 28TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4902
Country	:	US
Telephone Number	:	619-232-0179
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 6TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1643
Country	:	US
Telephone Number	:	619-232-0179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	05/15/2024

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