Individual
LILY WIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12983 SOUTHERN BLVD, SUITE 100, LOXAHATCHEE, FL 33470-9207
(561) 798-3300
Mailing address
1091 WIDGEON RD, WELLINGTON, FL 33414-5049
(561) 798-3300
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS11572
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008571300
—
FL
Enumeration date
02/02/2012
Last updated
09/24/2013
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