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General NPI Number Information
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NPI Number | 1225150501
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Entity Type | Individual
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Provider Name | MARY PATRICIA WISELY M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2366 OAK VALLEY DR
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City | ANN ARBOR
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State | MI
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Zip | 48103-8944
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Country | US
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Telephone | 734-662-5068
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 368 PARTNERS IN HEALING
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City | DEXTER
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State | MI
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Zip | 48130-0368
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Country | US
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Telephone | 734-646-0933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301071952
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License Number State | MN
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