Organization
LORI M WISELY M D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI M WISELY MD (PHYSICIAN)
(765) 675-2069
Entity
Organization
Contact information
Practice address
1060 S MAIN ST, TIPTON, IN 46072-8327
(765) 675-2069
(765) 675-7327
Mailing address
1060 S MAIN ST, PO BOX 286, TIPTON, IN 46072-8327
(765) 675-2069
(765) 675-7327
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042996
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200106590A
—
IN
Enumeration date
05/16/2008
Last updated
05/16/2008
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