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General NPI Number Information
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NPI Number | 1619472594
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Entity Type | Individual
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Provider Name | MICHAEL WYSOTA MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 1101 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-3612
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Country | US
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Telephone | 215-955-8988
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 N HANCOCK ST APT H0814
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1889
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Country | US
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Telephone | 516-521-8811
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD485195
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License Number State | PA
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