Individual
CRAIG W WIESENHUTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
950 W IRONWOOD DR, COEUR D ALENE, ID 83814-2644
(208) 765-5457
(208) 765-6248
Mailing address
950 W IRONWOOD DR, COEUR D ALENE, ID 83814-2644
(208) 765-5457
(208) 765-6248
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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