Dr Kyle Matthew Waisanen, MD is a medicare enrolled "Urology" physician in Petoskey, Michigan. His current practice location is
923 Spring St Ste 101, Petoskey, Michigan. You can reach out to his office (for appointments etc.) via phone at
(239) 763-0345.
Dr Kyle Matthew Waisanen is licensed to practice in Michigan (license number 4301513351) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1033616909.
Physician's Profile
Full Name | Dr Kyle Matthew Waisanen |
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Gender | Male |
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Speciality | Urology |
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Location | 923 Spring St Ste 101, Petoskey, Michigan |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1033616909
- Provider Enumeration Date: 04/09/2018
- Last Update Date: 09/03/2025
Medicare PECOS Information:
- PECOS PAC ID: 8820335888
- Enrollment ID: I20230712002562
Medical Identifiers
Medical identifiers for Dr Kyle Matthew Waisanen such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1033616909 | NPI | - | NPPES |
118384100 | Medicaid | FL | |
4301513351 | Other | MI | MI LICENSE |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208800000X | Urology | 4301513351 (Michigan) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kyle Matthew Waisanen allows following entities to bill medicare on his behalf.
Entity Name | Lee Memorial Health System |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1992873319 PECOS PAC ID: 8729996608 Enrollment ID: O20031118000604 |
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Entity Name | Lee Health System Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1942058557 PECOS PAC ID: 9335672146 Enrollment ID: O20241114001576 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kyle Matthew Waisanen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Kyle Matthew Waisanen, MD 923 Spring St Ste 101, Petoskey, MI 49770-2800 Ph: (239) 763-0345 | Dr Kyle Matthew Waisanen, MD 923 Spring St Ste 101, Petoskey, MI 49770-2800 Ph: (239) 763-0345 |
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