Healthcare Provider Details

I. General information

NPI: 1073545273
Provider Name (Legal Business Name): KATHRYN M WISSER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 BEECHER RD
FLINT MI
48532-3608
US

IV. Provider business mailing address

4255 BEECHER RD
FLINT MI
48532-3608
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-3522
  • Fax: 810-762-4526
Mailing address:
  • Phone: 810-232-3522
  • Fax: 810-762-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number146371
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0058674
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101016749
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: