Individual
MRS. LORI M WISELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1060 S MAIN ST;, SUITE 4, TIPTON, IN 46072-8327
(765) 675-2069
(765) 675-7327
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042996A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200106590
—
IN
05
—
200106590A
—
IN
Enumeration date
10/27/2005
Last updated
11/25/2020
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