Individual
KENNETH NIEL WIESERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5868 E 71ST ST, #123, INDIANAPOLIS, IN 46220-4002
(317) 885-2334
Mailing address
4412 RADNOR RD, INDIANAPOLIS, IN 46226-2150
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01026404A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100189000
—
IN
Enumeration date
05/16/2006
Last updated
07/13/2007
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