Individual
PATRICK JOSEPH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6435 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6203
(708) 280-5693
Mailing address
6435 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6203
(708) 280-5693
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101019463
MI
208M00000X
Hospitalist Physician
Primary
02004428A
IN
390200000X
Student in an Organized Health Care Education/Training Program
5101019463
MI
Other
Enumeration date
06/16/2011
Last updated
08/11/2014
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