NPI Code Detail JSON Logo

1255570800 NPI number — KIMBERLYDAWN WISDOM M.D.

NPI Number: 1255570800
Health Care Provider/Practitioner: KIMBERLYDAWN WISDOM M.D.

Information about “1255570800” NPI (KIMBERLYDAWN WISDOM M.D.) exists in 1255570800 in HTML format HTML  |  1255570800 in plain Text format TXT  |  1255570800 in PDF (Portable Document Format) PDF  |  1255570800 in an XML format XML  formats.

NPI Number : 1255570800 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255570800",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WISDOM",
    "FirstName": "KIMBERLYDAWN",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1 FORD PL # 5B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DETROIT",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48202-3450",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-876-8417",
    "MailingAddressFaxNumber": "313-876-9243",
    "FirstLinePracticeLocationAddress": "1 FORD PL # 5B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DETROIT",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48202-3450",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-876-8417",
    "PracticeLocationAddressFaxNumber": "313-876-9243",
    "EnumerationDate": "02/05/2009",
    "LastUpdateDate": "10/26/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2083P0901X",
          "TaxonomyName": "Public Health & General Preventive Medicine Physician",
          "LicenseNumber": "4301048817",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "4301048817",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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