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NPI Code Detail

MEDICARE: ANDREA E WISMANN M.D.

MEDICARE: ANDREA E WISMANN M.D.
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician39061OK
2207Q00000XFamily Medicine PhysicianDR0051260CO

General Provider Information

NPI Number : 1073756045
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA E WISMANN M.D.
Provider Business Mailing Address
First Line : 102 WOODMONT BLVD STE 600
Second Line :
City : NASHVILLE
State : TN
Zip : 37205-5250
Country : US
Telephone Number : 888-987-1151
Fax Number :
Provider Business Practice Location Address
First Line : 6951 SE 15TH ST
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-2748
Country : US
Telephone Number : 405-233-0450
Fax Number : 405-984-4407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2009
Last Update Date : 01/07/2026

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Directions to “ ANDREA E WISMANN M.D.” Practice Location

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