Provider Demographics
NPI:1003994096
Name:WISER, LEAH (PA)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:WISER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5200
Mailing Address - Country:US
Mailing Address - Phone:269-387-3290
Mailing Address - Fax:269-387-2944
Practice Address - Street 1:1903 W MICHIGAN AVE
Practice Address - Street 2:SINDECUSE HEALTH CENTER, WESTERN MICHIGAN UNIVERSITY
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5200
Practice Address - Country:US
Practice Address - Phone:269-387-3287
Practice Address - Fax:269-387-2944
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002257363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0853911050OtherBLUE CROSS BLUE SHIELD
0C94735OtherBCBS GROUP
0M22440022Medicare PIN
0C94735OtherBCBS GROUP