Individual
ALEX WIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
100 MALLARD CREEK RD, LOUISVILLE, KY 40207-4194
(502) 855-6130
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 559-9425
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05428
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2020
Last updated
08/22/2023
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