Individual
MICHAEL L WERTHEIMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
726 GOODMAN RD E # B, SOUTHAVEN, MS 38671-9530
(662) 349-1959
(662) 349-0424
Mailing address
726 GOODMAN RD E # B, SOUTHAVEN, MS 38671-9530
(662) 349-1959
(662) 349-0424
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
21002
MS
207W00000X
Ophthalmology Physician
MD0000045703
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4277943
BCBS TN
TN
01
—
XXXXX5420
BCBS
MS
Enumeration date
06/26/2008
Last updated
09/19/2012
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