Individual
MICHAEL G WIERSCHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5425 W SPRING CREEK PKWY, SUITE 150, PLANO, TX 75024-4236
(972) 403-5425
(214) 501-1252
Mailing address
PO BOX 911220, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
K7120
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104042004
—
TX
05
—
104042005
—
TX
01
—
751531693
TAX ID #
TX
01
—
8B6833
MEDICARE PTAN
—
01
—
P01843066
RAILROAD
TX
Enumeration date
09/14/2006
Last updated
04/13/2018
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