MEDICARE: DR. DAVID S WISHNEW M.D.

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	208200000X	Plastic Surgery Physician	G7380	TX
2	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	G7380	TX
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	G7380	TX

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	:	1487661724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S WISHNEW M.D.

Provider Business Mailing Address
First Line	:	6633 E HWY 290
Second Line	:	STE 101
City	:	AUSTIN
State	:	TX
Zip	:	78723-1172
Country	:	US
Telephone Number	:	512-314-3834
Fax Number	:	512-314-7121

Provider Business Practice Location Address
First Line	:	6633 E HWY 290
Second Line	:	STE 101
City	:	AUSTIN
State	:	TX
Zip	:	78723-1172
Country	:	US
Telephone Number	:	512-314-3834
Fax Number	:	512-314-7121

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/02/2009

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Directions to “ DR. DAVID S WISHNEW M.D.” Practice Location

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