Individual
DR. JOHN MICHAEL WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1006 W MAIN ST, BOZEMAN, MT 59715-3219
(406) 586-8711
(406) 587-2602
Mailing address
1006 W MAIN ST, BOZEMAN, MT 59715-3219
(406) 586-8711
(406) 587-2602
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4048
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930037579
RAILROAD MEDICARE
MT
Enumeration date
09/12/2005
Last updated
06/17/2008
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