Individual
DON EDWARD WIESE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-2000
Mailing address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-2000
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
48546
MN
2085R0202X
Diagnostic Radiology Physician
Primary
48546
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114908159
—
MN
Enumeration date
11/08/2005
Last updated
07/22/2021
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