Individual
TIMOTHY ANDREW WIENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3399 STRAUSS AVE, INDIAN HEAD, MD 20640-5164
(301) 744-2038
Mailing address
3934 SCANLAND RD, INDIAN HEAD, MD 20640-4425
(661) 317-1255
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/15/2016
Last updated
11/15/2016
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