# MICHAEL G WIERSCHEM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1215032149
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | K7120 | TX | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 04/13/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 104042004 | — | TX |
| 05 | — | 104042005 | — | TX |
| 01 | — | 751531693 | TAX ID \# | TX |
| 01 | — | 8B6833 | MEDICARE PTAN | — |
| 01 | — | P01843066 | RAILROAD | TX |