Individual
GREGORY A WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
28842
MN
2085N0904X
Nuclear Radiology Physician
28842
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
454819100
—
MN
Enumeration date
01/17/2006
Last updated
08/21/2020
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