Individual
DR. KENNETH E WIEMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1919 S WHEELING AVE, SUITE 300, TULSA, OK 74104-5638
(918) 748-7570
(918) 748-7573
Mailing address
1919 S WHEELING AVE, SUITE 300, TULSA, OK 74104-5638
(918) 748-7570
(918) 748-7573
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12545
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100162400A
—
OK
01
—
731346102
FEDERAL TAX ID
OK
Enumeration date
03/23/2006
Last updated
04/24/2008
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