Individual
PHILIPP ALEXANDER WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3800 S NATIONAL AVE, SPRINGFIELD, MO 65807-5209
(417) 875-2718
(417) 875-3737
Mailing address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3462
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
2019015689
MO
390200000X
Student in an Organized Health Care Education/Training Program
A126482
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200069960
—
MO
Enumeration date
06/26/2011
Last updated
12/10/2025
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