Healthcare Provider Details

I. General information

NPI: 1285016790
Provider Name (Legal Business Name): JOSHUA WISEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 ND AND EMILE
OMAHA NE
68198-0001
US

IV. Provider business mailing address

2717 ELLSWORTH AVE
BELLEVUE NE
68123-1738
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6329
  • Fax:
Mailing address:
  • Phone: 801-675-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7529
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-150491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: