Individual
MR. MARK L WIESNER
Active
Individual
MR. MARK L WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
31069
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01310697
—
CO
05
—
0725614
—
IA
05
—
107825900
—
WY
01
—
841287602
CHAMPUS
CO
01
—
WIA4011
ANTHEM BCBS
CO
Enumeration date
11/25/2005
Last updated
06/02/2026
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