Individual
MIKE WILLIAM WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E ROSS AVE, SAPULPA, OK 74066-6425
(918) 227-2016
(918) 227-5875
Mailing address
101 E ROSS AVE, SAPULPA, OK 74066-6425
(918) 227-2016
(918) 227-5875
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/15/2009
Last updated
01/15/2009
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