Individual
JEFFREY MARK WIISANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 4TH ST N, FARGO, ND 58102-4539
(701) 234-6161
(701) 234-7592
Mailing address
820 4TH ST N, FARGO, ND 58102-4539
(701) 234-6161
(701) 234-7592
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
58264
MN
207RH0003X
Hematology & Oncology Physician
Primary
58264
MN
Other
Enumeration date
05/21/2013
Last updated
09/17/2019
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