Doctor Name: | MICHAEL WISE |
NPI Number: | 1922267210 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 114 W Elliott St Saint Ignace, MI - 497811868 |
Business Phone Number: | 9066438616 |
Business Fax Number: | 9066437194 |
Mailing Address: | 125 N Lake St, MANISTIQUE |
State: | MI |
Postal Code: | 498541234 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/03/2008 |
NPI Last Update Date: | 06/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |