Individual
DARYL D WISDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10015 CASCADE RD SE, LOWELL, MI 49331-9529
(616) 868-7551
(616) 868-7321
Mailing address
10015 CASCADE RD SE, LOWELL, MI 49331-9529
(616) 868-7551
(616) 868-7321
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301048819
MI
2083P0901X
Public Health & General Preventive Medicine Physician
4301048819
MI
Other
Enumeration date
08/14/2006
Last updated
10/28/2016
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