# LORI M WISELY M D

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831356062
- **Authorized official:** LORI M WISELY MD (PHYSICIAN)
- **Authorized official phone:** (765) 675-2069

## Contact information

- **Practice address:** 1060 S MAIN ST, TIPTON, IN 46072-8327
- **Practice address phone:** (765) 675-2069
- **Practice address fax:** (765) 675-7327
- **Mailing address:** 1060 S MAIN ST, PO BOX 286, TIPTON, IN 46072-8327
- **Mailing address phone:** (765) 675-2069
- **Mailing address fax:** (765) 675-7327

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01042996 | IN | Yes |

## Other

- **Enumeration date:** 05/16/2008
- **Last updated:** 05/16/2008