Individual
JODY LYNN WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
615 N MICHIGAN ST, 1ST FL HOSPITALIST STE, SOUTH BEND, IN 46601-1033
(574) 647-3050
(574) 647-1094
Mailing address
3245 HEALTH DRIVE, SUITE 100, GRANGER, IN 46530-3245
(574) 647-1840
(574) 647-1825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01050941A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200286510
—
IN
Enumeration date
12/09/2005
Last updated
04/28/2023
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