Provider Demographics
NPI:1902179088
Name:WISCHMEYER, SANDRA MARY
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARY
Last Name:WISCHMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-947-3117
Practice Address - Street 1:1507 WABASH ST STE 400D
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4361
Practice Address - Country:US
Practice Address - Phone:219-861-8828
Practice Address - Fax:219-868-8827
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005417A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery