Provider Demographics
NPI:1679649909
Name:WISEMAN, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-736-6133
Mailing Address - Fax:317-736-6403
Practice Address - Street 1:1155 W JEFFERSON ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2731
Practice Address - Country:US
Practice Address - Phone:317-736-6133
Practice Address - Fax:317-736-6403
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01050177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN080172441OtherRAILROAD MEDICARE
IN160030Medicare Oscar/Certification
IN080172441OtherRAILROAD MEDICARE