Provider Demographics
NPI:1073037636
Name:WISE, ROBERT ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ARTHUR
Last Name:WISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:181 BROWNTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-5113
Mailing Address - Country:US
Mailing Address - Phone:630-669-4628
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE STE 1025
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6264
Practice Address - Country:US
Practice Address - Phone:630-669-4628
Practice Address - Fax:630-669-4628
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360577762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry