Individual
LOREN M WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5629 STADIUM DR, SUITE D, KALAMAZOO, MI 49009-1952
(269) 372-5701
(269) 372-5702
Mailing address
601 JOHN ST, BOX 42, KALAMAZOO, MI 49007-5341
(269) 372-5701
(269) 372-5702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301078298
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4635894
—
MI
01
—
CA4396
RAILROAD MEDICARE
MI
Enumeration date
01/25/2006
Last updated
10/10/2014
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