BRIAN KEITH WISE MD NPI 1043211683

NPI Information

NPI: 1043211683
Provider Name: BRIAN KEITH WISE, MD
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

Organization: LIGHTHOUSE COMPLEX CARE LTD

PECOS Registration: Yes

Address:
1400 JACKSON ST
DENVER, CO
ZIP 80206
Phone: (303) 388-4461
Get Directions

Brian Keith Wise, MD is a child and adolescent psychiatry psychiatry neurology in Denver, CO with 24 years of experience. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. Brian Keith Wise, MD NPI is 1043211683. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE
Graduation Year:2000

The provider's business location address is:

1400 JACKSON ST
DENVER, CO
ZIP 80206-761
Phone: (303) 388-4461
Fax: (303) 398-1211

The NPI 1043211683 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/4/2005 and was last updated on 3/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0800X	Psychiatry & Neurology	Psychiatry	41287	COLORADO	No
2	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	41287	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1043211683	OTHER	COLORADO	NPI NUMBER
2	70583072	MEDICAID	COLORADO
3	C802299	OTHER	COLORADO	MEDICARE
4	C811544	OTHER	COLORADO	MEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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