Individual
MR. MICHAEL B WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5719 WIDEWATERS PKWY, SYRACUSE, NY 13214-1985
(315) 251-3100
(315) 449-9923
Mailing address
PO BOX 580, SYRACUSE, NY 13214-0580
(315) 251-3140
(315) 552-6046
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
175162
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01499807
—
NY
Enumeration date
03/10/2006
Last updated
12/05/2025
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