Provider Demographics
NPI:1649852013
Name:WISE WEIGHT MANAGEMENT PC
Entity type:Organization
Organization Name:WISE WEIGHT MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAFINA
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-272-3215
Mailing Address - Street 1:PO BOX 6412
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48608
Mailing Address - Country:US
Mailing Address - Phone:989-272-3215
Mailing Address - Fax:833-974-2434
Practice Address - Street 1:3069 BAY PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604
Practice Address - Country:US
Practice Address - Phone:989-272-3215
Practice Address - Fax:833-974-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty