NPI Code Detail JSON Logo

1841779485 NPI number — FUNKE ADEFOPE WISHKO MD

NPI Number: 1841779485
Health Care Provider/Practitioner: FUNKE ADEFOPE WISHKO MD

Information about “1841779485” NPI (FUNKE ADEFOPE WISHKO MD) exists in 1841779485 in HTML format HTML  |  1841779485 in plain Text format TXT  |  1841779485 in PDF (Portable Document Format) PDF  |  1841779485 in an XML format XML  formats.

NPI Number : 1841779485 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841779485",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WISHKO",
    "FirstName": "FUNKE",
    "MiddleName": "ADEFOPE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ADEFOPE",
    "OtherFirstName": "FUNKE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3612 216TH DR SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRIER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98036-8096",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "470-214-3374",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12303 NE 130TH LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KIRKLAND",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98034-3099",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "425-544-1000",
    "PracticeLocationAddressFaxNumber": "425-544-1001",
    "EnumerationDate": "08/13/2018",
    "LastUpdateDate": "11/17/2022",
    "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": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "MD61283257",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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