Individual
THEODORE WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 BANNOCK ST, DENVER, CO 80204
(303) 436-6000
Mailing address
450 W 14TH AVE #48004, DENVER, CO 80204
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
74236-20
WI
207P00000X
Emergency Medicine Physician
A155718
CA
207P00000X
Emergency Medicine Physician
Primary
DR.0058658
CO
Other
Enumeration date
03/28/2014
Last updated
09/02/2025
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