Individual
REBECCA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
49650 CHERRY HILL RD STE 210, CANTON, MI 48187-4859
(734) 398-7899
(734) 398-7895
Mailing address
24 FRANK LLOYD WRIGHT DR STE J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766
(734) 222-3100
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0102205010
VA
208000000X
Pediatrics Physician
Primary
5101025665
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891100954
—
VA
Enumeration date
06/27/2014
Last updated
10/08/2020
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