Provider Demographics
NPI:1053369827
Name:WAKEFIELD, TRACY J (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:WAKEFIELD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:J
Other - Last Name:SCHIFINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:702-843-2420
Mailing Address - Fax:833-749-0351
Practice Address - Street 1:2875 S NELLIS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2087
Practice Address - Country:US
Practice Address - Phone:702-843-2420
Practice Address - Fax:833-749-0351
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV66036OtherMEDICARE
NV1053369827Medicaid
G18327Medicare UPIN