Provider Demographics
NPI:1083673305
Name:WISLER, CAROLYN M (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:WISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:LEEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:4001 LONG PRAIRIE RD STE 140
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1564
Practice Address - Country:US
Practice Address - Phone:972-691-2388
Practice Address - Fax:972-691-2766
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7006208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0064PTOtherBCBS
TX161081801Medicaid
TX161081804Medicaid
TX161081807Medicaid
TX8AL412OtherBCBS
TX161081815Medicaid
TX161081813Medicaid
TX161081814OtherCSHCN
TX8B1706Medicare ID - Type Unspecified
TXTXB138716Medicare PIN
TX161081813Medicaid
TX161081801Medicaid