Individual
DR. KEITH WAYNE WISNIEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2202 ITHACA AVE, LUBBOCK, TX 79410-1332
(806) 797-1202
Mailing address
2202 ITHACA AVE, LUBBOCK, TX 79410-1332
(806) 797-1202
(806) 797-4854
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M5588
TX
Other
Enumeration date
03/01/2007
Last updated
06/05/2020
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