Provider Demographics
NPI:1619370376
Name:MILAN WISTER, M.D., LLC
Entity Type:Organization
Organization Name:MILAN WISTER, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-438-4925
Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 535
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:443-438-4925
Mailing Address - Fax:667-239-3970
Practice Address - Street 1:2 HAMILL RD
Practice Address - Street 2:SUITE 222
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1806
Practice Address - Country:US
Practice Address - Phone:410-653-0000
Practice Address - Fax:443-627-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty