| Lori M Wisely M D | |
|
1060 S Main St Tipton IN 46072-8327 | |
| (765) 675-2069 | |
| (765) 675-7327 |
| Full Name | Lori M Wisely M D |
|---|---|
| Speciality | Family Medicine |
| Location | 1060 S Main St, Tipton, Indiana |
| Authorized Official Name and Position | Lori M Wisely (PHYSICIAN) |
| Authorized Official Contact | 7656752069 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lori M Wisely M D 1060 S Main St Po Box 286 Tipton IN 46072-8327 Ph: (765) 675-2069 | Lori M Wisely M D 1060 S Main St Tipton IN 46072-8327 Ph: (765) 675-2069 |
| NPI Number | 1831356062 |
|---|---|
| Provider Enumeration Date | 05/16/2008 |
| Last Update Date | 05/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831356062 | NPI | - | NPPES |
| 200106590A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01042996 (Indiana) | Primary |
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