MEDICARE: HEALTHWISE MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1053579482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWISE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3941 J ST
Second Line	:	SUITE 250
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3624
Country	:	US
Telephone Number	:	916-733-6800
Fax Number	:	916-733-6811

Provider Business Practice Location Address
First Line	:	3941 J ST
Second Line	:	SUITE 250
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3624
Country	:	US
Telephone Number	:	916-733-6800
Fax Number	:	916-733-6811

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JUDY PENG
Credential	:
Telephone Number	:	916-733-6800

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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Directions to “HEALTHWISE MEDICAL GROUP ” Practice Location

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