Provider Demographics
NPI:1720091135
Name:WISK, DUANE FRANK (DO)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:FRANK
Last Name:WISK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MEADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6491
Mailing Address - Country:US
Mailing Address - Phone:313-641-0676
Mailing Address - Fax:
Practice Address - Street 1:960 MEADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-6491
Practice Address - Country:US
Practice Address - Phone:313-641-0676
Practice Address - Fax:616-392-8992
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010082372083P0500X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty