Healthcare Provider Details

I. General information

NPI: 1508974445
Provider Name (Legal Business Name): MARTIN NUROCK WISEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MAYFIELD ROAD SUITE 444
MAYFIELD HGTS OH
44124-2209
US

IV. Provider business mailing address

6801 MAYFIELD ROAD SUITE 444
MAYFIELD HGTS OH
44124-2209
US

V. Phone/Fax

Practice location:
  • Phone: 440-449-8890
  • Fax: 440-449-7580
Mailing address:
  • Phone: 440-449-8890
  • Fax: 440-449-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35059554W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: