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General NPI Number Information
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NPI Number | 1427105394
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Entity Type | Individual
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Provider Name | MARSHALL T WISE MD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 200 BEVINS LN STE E
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City | GEORGETOWN
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State | KY
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Zip | 40324-8532
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Country | US
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Telephone | 800-999-1249
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Fax | 855-656-7325
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Provider Business Mailing Address
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Address Line | 9800 SHELBYVILLE RD STE 220
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City | LOUISVILLE
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State | KY
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Zip | 40223-5440
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Country | US
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Telephone | 800-999-1249
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Fax | 855-656-7325
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 41014
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 35.099667
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License Number State | OH
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