Healthcare Provider Details

I. General information

NPI: 1043602899
Provider Name (Legal Business Name): MORGAN M WISE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MORGAN MACKENZIE WISE D.O.

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 NE BLAKELY DR
ISSAQUAH WA
98029-6201
US

IV. Provider business mailing address

751 NE BLAKELY DR
ISSAQUAH WA
98029-6201
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60945089
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02006271A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101021512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: