Healthcare Provider Details

I. General information

NPI: 1003036997
Provider Name (Legal Business Name): CHRISTOPHER L WISE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 600
KANSAS CITY MO
64116-3274
US

IV. Provider business mailing address

19550 E 39TH ST STE 410
INDEPENDENCE MO
64057
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-3003
  • Fax: 816-889-1584
Mailing address:
  • Phone: 816-303-2400
  • Fax: 816-303-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2008008638
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2008008638
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: