Healthcare Provider Details

I. General information

NPI: 1598195042
Provider Name (Legal Business Name): WISEMAN FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S LAKELINE BLVD SUITE 100
CEDAR PARK TX
78613-2967
US

IV. Provider business mailing address

2500 S LAKELINE BLVD SUITE 100
CEDAR PARK TX
78613-2967
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-8970
  • Fax: 512-345-6689
Mailing address:
  • Phone: 512-345-8970
  • Fax: 512-345-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9746
License Number StateTX

VIII. Authorized Official

Name: ALICIA MICHEL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 512-345-8970