Individual
JEROME J WISNESKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2338 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49504-5969
(616) 453-7898
Mailing address
2338 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49504-5969
(616) 453-7898
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301027855
MI
Other
Enumeration date
11/10/2009
Last updated
11/10/2009
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