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NPI Code Detail

MEDICARE: PETER F WISNIEWSKI I D.O.

MEDICARE: PETER F WISNIEWSKI I D.O.
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
1207Q00000XFamily Medicine Physician323886LA
2207Q00000XFamily Medicine Physician08960MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548231269
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER F WISNIEWSKI I D.O.
Provider Business Mailing Address
First Line : 706 ROSS ST
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-9798
Country : US
Telephone Number : 318-428-3237
Fax Number : 183-428-1362
Provider Business Practice Location Address
First Line : 706 ROSS ST
Second Line :
City : OAK GROVE
State : LA
Zip : 71263-9798
Country : US
Telephone Number : 318-428-3237
Fax Number : 318-428-1362
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 03/13/2025

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Directions to “ PETER F WISNIEWSKI I D.O.” Practice Location

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