Provider Demographics
NPI:1245378819
Name:WISHNER, HARLEY M (MD)
Entity Type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:M
Last Name:WISHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8040
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-8040
Mailing Address - Country:US
Mailing Address - Phone:818-231-1440
Mailing Address - Fax:818-225-1572
Practice Address - Street 1:22540 DARDENNE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5823
Practice Address - Country:US
Practice Address - Phone:818-231-1440
Practice Address - Fax:818-225-1572
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG38891208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology