Provider Demographics
NPI:1548231269
Name:WISNIEWSKI, PETER F I (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:F
Last Name:WISNIEWSKI
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-9798
Mailing Address - Country:US
Mailing Address - Phone:318-428-3237
Mailing Address - Fax:183-428-1362
Practice Address - Street 1:706 ROSS ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-9798
Practice Address - Country:US
Practice Address - Phone:318-428-3237
Practice Address - Fax:318-428-1362
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323886207Q00000X
MS08960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07728748Medicaid
LA1554189Medicaid
MSD80494Medicare UPIN