Individual
KENDALL L WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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