Individual
MAX V. WISGERHOF II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24 FRANK LLOYD WRIGHT DR, LOBBY C SUITE 1300, ANN ARBOR, MI 48105-9484
(734) 647-5871
Mailing address
3621 SOUTH STATE STREET, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301039438
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
4301039438
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140750910
—
MI
01
—
700H262220
BLUE CROSS-BLUE CROSS
—
01
—
MW039438
CHAMPUS-CHAMPUS
—
Enumeration date
12/01/2006
Last updated
10/06/2014
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