JUSTIN POK WISELY MD
NPI 1780326595
Student in an Organized Health Care Education/Training Program in Jackson, MI

Q: What is Justin Wisely's NPI number?

The NPI number for Justin Wisely is 1780326595. It was assigned to this individual provider in the NPPES registry on April 12, 2022.

Q: What is Justin Wisely's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Justin Wisely was last updated on April 12, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 12, 2022PECOS Enrolled

205 N EAST AVE, JACKSON, MI 49201(800) 436-7936 Get Directions Write a Review

NPPES record last updated: April 12, 2022. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Justin Pok Wisely Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JUSTIN POK WISELY MD (NPI 1780326595) is an individual student in an organized health care education/training program in Jackson, Michigan and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1780326595

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJUSTIN POK WISELYCredential: MD

Location Address205 N EAST AVEJackson, MI 49201-1753

Mailing Address205 N East AveJackson, MI 49201-1753

Phone(800) 436-7936

Sole ProprietorNo

Enumeration DateApril 12, 2022

NPPES CertifiedApril 12, 2022

✔ NPI 1780326595 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

205 N EAST AVE, Jackson, MI 49201

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Justin Pok Wisely Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SAMANTHA RENE DANEK PA-C

Physician Assistant