MEDICARE: WISE PSYCHIATRY, PC

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	2084P0800X	Psychiatry Physician	41287	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548552656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE PSYCHIATRY, PC

Provider Business Mailing Address
First Line	:	6053 S QUEBEC ST STE 203
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4505
Country	:	US
Telephone Number	:	720-708-4287
Fax Number	:	720-787-9946

Provider Business Practice Location Address
First Line	:	6053 S QUEBEC ST STE 203
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4505
Country	:	US
Telephone Number	:	720-708-4287
Fax Number	:	720-815-2581

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN KEITH WISE
Credential	:	MD
Telephone Number	:	720-708-4287

Provider Enumeration Date	:	05/07/2011
Last Update Date	:	10/16/2024

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