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NPI Code Detail

MEDICARE: LAURA WISE M.D.

MEDICARE: LAURA WISE 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
1207Q00000XFamily Medicine PhysicianA73054CA

General Provider Information

NPI Number : 1326234774
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA WISE M.D.
Provider Business Mailing Address
First Line : 1 EMBARCADERO CTR STE 1900
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94111-3723
Country : US
Telephone Number : 415-658-6791
Fax Number :
Provider Business Practice Location Address
First Line : 1801 SHATTUCK AVE STE A
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1872
Country : US
Telephone Number : 510-225-1025
Fax Number : 415-252-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2007
Last Update Date : 03/14/2025

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