Organization
DR. SHOUKRI M. WISA MEDICAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHOUKRI MINA WISA M.D. (OWNER)
(585) 343-6363
Entity
Organization
Contact information
Practice address
164 WASHINGTON AVE, BATAVIA, NY 14020-2113
(585) 343-6363
(585) 343-1986
Mailing address
164 WASHINGTON AVE, BATAVIA, NY 14020-2113
(585) 343-6363
(585) 343-1986
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01127023
—
NY
Enumeration date
09/11/2007
Last updated
04/03/2014
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