Individual
KENDALL L WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1044 GOODLETTE RD N., NAPLES, FL 34102
(239) 261-5400
(239) 261-4387
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME53290
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038093800
—
FL
01
—
05823
BCBS
FL
01
—
1193523
WELLCARE
FL
01
—
315207
AVMED
FL
01
—
340007341
RRMC
FL
01
—
5340047
AETNA PROVIDER ID
FL
01
—
P00796370
RAILROAD MEDICARE
FL
Enumeration date
12/18/2006
Last updated
04/20/2016
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