Individual
MS. ELEANOR RACHAEL WIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
26025 LAHSER RD FL 2, SOUTHFIELD, MI 48033-2606
(248) 663-1900
(844) 598-9633
Mailing address
26211 CENTRAL PARK BLVD STE 201, SOUTHFIELD, MI 48076-4158
(833) 667-3627
(833) 972-5509
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601011030TMP22
MI
Other
Enumeration date
02/28/2022
Last updated
04/22/2026
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