# KURT WIESE, MD PC

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

## Provider details

- **NPI number:** 1346426533
- **Authorized official:** MR. KURT WIESE M.D (OWNER)
- **Authorized official phone:** (219) 462-7773

## Contact information

- **Practice address:** 401 WALL ST, SUITE B, VALPARAISO, IN 46383-2521
- **Practice address phone:** (219) 462-7773
- **Practice address fax:** (219) 531-5988
- **Mailing address:** 401 WALL ST, SUITE B, VALPARAISO, IN 46383-2521
- **Mailing address phone:** (219) 462-7773
- **Mailing address fax:** (219) 531-5988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 01040290 | IN | Yes |

## Other

- **Enumeration date:** 01/17/2008
- **Last updated:** 02/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000091658 | ANTHEM | IN |