Provider Demographics
NPI:1053474585
Name:WISEMAN, PATRICIA G (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-0800
Mailing Address - Country:US
Mailing Address - Phone:317-736-6133
Mailing Address - Fax:317-736-6403
Practice Address - Street 1:3000 S STATE ROAD 135 STE 200
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9829
Practice Address - Country:US
Practice Address - Phone:317-535-1876
Practice Address - Fax:317-535-5049
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN080172495OtherRAILROAD MEDICARE
IN200286440Medicaid
H21278Medicare UPIN