Provider Demographics
NPI:1780999359
Name:WISEMAN, CHEYENNE LEILA (MD)
Entity type:Individual
Prefix:DR
First Name:CHEYENNE
Middle Name:LEILA
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEILA
Other - Middle Name:CHEYENNE
Other - Last Name:SOBIENIAK-WISEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E WISCONSIN AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4815
Practice Address - Country:US
Practice Address - Phone:414-290-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000051526207P00000X
CAA118842207P00000X
WI64038-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine