Individual
MARC S WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER DR, FRANKLIN, OH 45005-2584
(513) 312-3656
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
26113
NE
207P00000X
Emergency Medicine Physician
Primary
35085676
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000375342
BCBS MEMORIAL
OH
01
—
000000375345
BCBS CIRCLEVILLE
OH
01
—
000000481153
BCBS FAIRFIELD
OH
01
—
000000487936
BCBS MIDDLETOWN
OH
05
—
2603552
—
OH
Enumeration date
05/15/2006
Last updated
04/14/2011
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