| Doctor Name: | JEFFREY L WISNICKI |
| NPI Number: | 1154406080 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME48094 |
| Business Practice Address: | 13005 Southern Blvd Suite 133 Palms West Medical Mall One Loxahatchee, FL - 33470 |
| Business Phone Number: | 5617981400 |
| Business Fax Number: | 5617980255 |
| Mailing Address: | 13005 Southern Blvd Ste 133, Palms West Medical Mall One LOXAHATCHEE |
| State: | FL |
| Postal Code: | 334709231 |
| Phone Number: | 5617981400 |
| Fax Number: | 5617980255 |
| NPI Enumeration Date: | 10/26/2006 |
| NPI Last Update Date: | 02/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | ME48094 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |