Individual
MICHAEL ALAN WIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 WEST ESPLANADE AVENUE, KENNER, LA 70065
(504) 842-7588
Mailing address
1514 JEFFERSON HIGHWAY, NEW ORLEANS, LA 70121
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD017792
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09459713
—
MS
05
—
1112151
—
LA
05
—
1380580
—
LA
Enumeration date
05/17/2006
Last updated
07/20/2010
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