Healthcare Provider Details

I. General information

NPI: 1013091412
Provider Name (Legal Business Name): STEPHEN WILLIAM WISEMAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2335
US

IV. Provider business mailing address

2919 BURLINGTON CT
ANN ARBOR MI
48105-1479
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-7100
  • Fax: 734-761-5590
Mailing address:
  • Phone: 734-663-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36784
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302025614
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: