Individual
WILLIAM REX WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
110 LONGWOOD AVE, ROCKLEDGE, FL 32955-2828
(321) 636-2211
Mailing address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 764-3270
(734) 936-7361
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
OS15712
FL
390200000X
Student in an Organized Health Care Education/Training Program
5101018518
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101514800
—
FL
01
—
KN896
MEDICARE
FL
Enumeration date
10/16/2009
Last updated
08/26/2019
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