Individual
BRETT MARVIN WIESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 COTTMAN AVE, PHILADELPHIA, PA 19111-2434
(215) 728-6900
(215) 214-1734
Mailing address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
(215) 707-3911
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD494110
PA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/09/2020
Last updated
06/11/2026
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