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Individual
WILLIAM J WIEDEMER
Active
Individual
WILLIAM J WIEDEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC004522L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000505853
HIGHMARK BLUE SHIELD INDV
PA
01
—
000546370
HIGHMARK BLUE SHLD GRP
PA
05
—
0018087500001
—
PA
Enumeration date
03/17/2006
Last updated
06/20/2023
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