Provider Demographics
NPI:1508974445
Name:WISEMAN, MARTIN NUROCK (MD)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:NUROCK
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MAYFIELD ROAD
Mailing Address - Street 2:SUITE 444
Mailing Address - City:MAYFIELD HGTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2209
Mailing Address - Country:US
Mailing Address - Phone:440-449-8890
Mailing Address - Fax:440-449-7580
Practice Address - Street 1:6801 MAYFIELD ROAD
Practice Address - Street 2:SUITE 444
Practice Address - City:MAYFIELD HGTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2209
Practice Address - Country:US
Practice Address - Phone:440-449-8890
Practice Address - Fax:440-449-7580
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059554W207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000142196OtherANTHEM
OH2382068OtherAETNA HMO
OH3419207200OtherBWC
OH0881783Medicaid
OH4306387OtherAETNA NON HMO
OH0881783Medicaid
WI0672916Medicare ID - Type Unspecified