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Individual

RICHARD ALLEN WIETHOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
225 S PINE ST SUITE 310, SEYMOUR, IN 47274
(812) 522-2177
(812) 522-4069
Mailing address
1613 BELL FORD DR, SEYMOUR, IN 47274
(812) 522-2177
(812) 522-4069

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01024324
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00000084530
ANTHEM
IN
05
20000020A
IN
Enumeration date
12/06/2006
Last updated
07/08/2007
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