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NPI Code Detail

MEDICARE: DR. MARY PATRICIA WISELY M.D.

MEDICARE: DR. MARY PATRICIA WISELY M.D.
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician4301071952MN

General Provider Information

NPI Number : 1225150501
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY PATRICIA WISELY M.D.
Provider Business Mailing Address
First Line : PO BOX 368
Second Line : PARTNERS IN HEALING
City : DEXTER
State : MI
Zip : 48130-0368
Country : US
Telephone Number : 734-646-0933
Fax Number :
Provider Business Practice Location Address
First Line : 2366 OAK VALLEY DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-8944
Country : US
Telephone Number : 734-662-5068
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 07/08/2007

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