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Individual

DR. RICHARD M WIET

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
25 N WINFIELD RD STE 424, WINFIELD, IL 60190-1379
(630) 933-4056
(630) 933-4057
Mailing address
25 N WINFIELD RD STE 424, WINFIELD, IL 60190-1379
(630) 933-4056
(630) 933-4057

Taxonomy

Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
036119686
IL
207YX0901X
Otology & Neurotology Physician
4301087453
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
400280
GROUP MEDICARE PTAN
IL
01
403270
GROUP MEDICARE PTAN
IL
Enumeration date
11/21/2006
Last updated
11/22/2023
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