Individual
SUSAN H WIEBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
801 W 8TH ST, COFFEYVILLE, KS 67337-4109
(620) 688-6566
(620) 688-6577
Mailing address
PO BOX 505262, SAINT LOUIS, MO 63150-5262
(620) 688-6566
(620) 688-6577
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30484
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104615
BCBS
KS
01
—
107906
HPK
KS
01
—
12381073
MULTIPLAN
KS
05
—
200316370A
—
KS
01
—
236567
COVENTRY
KS
01
—
8859
PHS
KS
Enumeration date
08/06/2006
Last updated
10/21/2015
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