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1417908385

NPI Code Detail

MEDICARE: MARC S WISE MD

MEDICARE: MARC S WISE MD

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
1	207P00000X	Emergency Medicine Physician	35085676	OH
2	207P00000X	Emergency Medicine Physician	26113	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000481153	OTHER	OH	BCBS FAIRFIELD
2	000000375342	OTHER	OH	BCBS MEMORIAL
3	000000375345	OTHER	OH	BCBS CIRCLEVILLE
4	000000487936	OTHER	OH	BCBS MIDDLETOWN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417908385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC S WISE MD

Provider Business Mailing Address
First Line	:	4750 HEMPSTEAD STATION DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5164
Country	:	US
Telephone Number	:	800-875-0136
Fax Number	:	937-619-4150

Provider Business Practice Location Address
First Line	:	1 MEDICAL CENTER DR
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-2584
Country	:	US
Telephone Number	:	513-312-3656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	04/14/2011

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Directions to “ MARC S WISE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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