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General NPI Number Information
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NPI Number | 1962493551
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Entity Type | Individual
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Provider Name | CHARLES LOUIS WISEMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 8900 WILSHIRE BLVD, SECOND FLOOR
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1958
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Country | US
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Telephone | 323-377-4741
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Fax | 626-577-9069
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Provider Business Mailing Address
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Address Line | 8900 WILSHIRE BLVD, SECOND FLOOR
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1958
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Country | US
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Telephone | 323-377-4741
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Fax | 626-577-9069
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A24132
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | A24132
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License Number State | CA
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