MEDICARE: FREDERICK WISEMAN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	5901000866	MI

General Provider Information

NPI Number	:	1972506558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK WISEMAN DPM

Provider Business Mailing Address
First Line	:	PO BOX 730
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-0730
Country	:	US
Telephone Number	:	269-651-2320
Fax Number	:	269-659-4704

Provider Business Practice Location Address
First Line	:	102 S LAKEVIEW AVE
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-1947
Country	:	US
Telephone Number	:	269-651-2320
Fax Number	:	269-659-4704

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/01/2012

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Directions to “ FREDERICK WISEMAN DPM” Practice Location

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