MEDICARE: DR. MERRILL S WISE III 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
1	2080S0012X	Pediatric Sleep Medicine Physician	41144	TN
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	41144	TN

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	:	1922089192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERRILL S WISE III M.D.

Provider Business Mailing Address
First Line	:	5050 POPLAR AVE
Second Line	:	SUITE 800
City	:	MEMPHIS
State	:	TN
Zip	:	38157-0101
Country	:	US
Telephone Number	:	901-276-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 POPLAR AVE
Second Line	:	SUITE 800
City	:	MEMPHIS
State	:	TN
Zip	:	38157-0101
Country	:	US
Telephone Number	:	901-276-2662
Fax Number	:	901-274-2033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	02/17/2020

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