Individual
CRAIG W WIESENHUTTER
Active
Individual
CRAIG W WIESENHUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
M4720
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005797
BLUE SHIELD
—
05
—
002074200
—
ID
01
—
47209
BLUE CROSS
—
Enumeration date
01/23/2007
Last updated
03/18/2011
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