# MEGAN S K WIESE MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033394002
- **Authorized official:** DOUG WIESE (OFFICE MANAGER)
- **Authorized official phone:** (928) 854-6249

## Contact information

- **Practice address:** 2130 MESQUITE AVE UNIT 106, LAKE HAVASU CITY, AZ 86403-6897
- **Practice address phone:** (928) 854-6249
- **Practice address fax:** (928) 854-6301
- **Mailing address:** 2130 MESQUITE AVE UNIT 106, LAKE HAVASU CITY, AZ 86403-6897
- **Mailing address phone:** (928) 854-6249
- **Mailing address fax:** (928) 854-6301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 29168 | AZ | Yes |

## Other

- **Enumeration date:** 01/08/2008
- **Last updated:** 10/02/2012