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NPI Code Detail

MEDICARE: TRACY J WAKEFIELD MD

MEDICARE: TRACY J WAKEFIELD MD
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
1207R00000XInternal Medicine Physician8072NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V66036OTHERNVMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053369827
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY J WAKEFIELD MD
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 702-843-2420
Fax Number : 833-749-0351
Provider Business Practice Location Address
First Line : 2875 S NELLIS BLVD STE 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-2087
Country : US
Telephone Number : 702-843-2420
Fax Number : 833-749-0351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 02/26/2025

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Directions to “ TRACY J WAKEFIELD MD” Practice Location

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