Provider Demographics
NPI:1053474585
Name:WISEMAN, PATRICIA G (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-736-6133
Mailing Address - Fax:317-736-6403
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2730
Practice Address - Country:US
Practice Address - Phone:317-736-6133
Practice Address - Fax:317-736-6403
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN080172495OtherRAILROAD MEDICARE
IN080172495OtherRAILROAD MEDICARE
H21278Medicare UPIN