Healthcare Provider Details

I. General information

NPI: 1265177760
Provider Name (Legal Business Name): MICAELA STEVENSON-WYSZEWIANSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICAELA STEVENSON MD

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 OLD CLINIC BUILDING CB 7570
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-2131
  • Fax:
Mailing address:
  • Phone: 414-805-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2026-02219
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: