Individual
MARK A WIECHERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1707 N HENDERSON ST, GALESBURG, IL 61401-1320
(309) 343-1000
(309) 344-1054
Mailing address
1707 N HENDERSON ST, GALESBURG, IL 61401-1320
(309) 343-1000
(309) 344-1054
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11054102
CAQH
—
01
—
4815127
BC/BS
—
01
—
5471051
AETNA
—
Enumeration date
09/26/2006
Last updated
07/08/2007
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