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Individual

MR. RICHARD LEE WIESEMANN II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
980 W IRONWOOD DR STE 104, COEUR D ALENE, ID 83814-2668
(208) 667-0621
Mailing address
1555 LIBERTY LN STE C, MISSOULA, MT 59808-2001
(406) 728-9545

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MT 543
MT
363AM0700X
Medical Physician Assistant
Primary
PA-2733
ID

Other

Enumeration date
10/10/2008
Last updated
04/07/2026
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