Individual
DR. MICHAEL J WIESER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 MEDICAL DR, SUITE A, LIMA, OH 45804-4099
(419) 222-6622
(419) 224-0015
Mailing address
801 MEDICAL DR, SUITE A, LIMA, OH 45804-4099
(419) 222-6622
(419) 224-0015
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
35051495-W
OH
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
35.051495
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000020356
ANTHEM
OH
05
—
0704705
—
OH
Enumeration date
01/19/2006
Last updated
04/06/2010
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