Individual
WILLIAM J WIEDEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
711 LOGAN BLVD, ALTOONA, PA 16602-4165
(814) 943-3668
(814) 942-7635
Mailing address
711 LOGAN BLVD, ALTOONA, PA 16602-4165
(814) 943-3668
(814) 942-7635
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC004522L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000505853
HIGHMARK BLUE SHIELD INDV
PA
01
—
000546370
HIGHMARK BLUE SHLD GRP
PA
05
—
0018087500001
—
PA
Enumeration date
03/17/2006
Last updated
06/20/2023
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