| Doctor Name: | DR. JASON ROMAN WISNIEWSKI |
| NPI Number: | 1598970477 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 930-025 |
| Business Practice Address: | 2483 Corporate Cir East Troy, WI - 531202575 |
| Business Phone Number: | 2626422000 |
| Business Fax Number: | 2626422143 |
| Mailing Address: | 308 Morrissey Dr, NORTH PRAIRIE |
| State: | WI |
| Postal Code: | 531539733 |
| Phone Number: | 2623495211 |
| Fax Number: | |
| NPI Enumeration Date: | 05/13/2007 |
| NPI Last Update Date: | 09/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 930-025 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |