Individual
KURT ALAN WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 WALL ST, SUITE B, VALPARAISO, IN 46383-2521
(219) 462-7773
(219) 531-5988
Mailing address
401 WALL ST, SUITE B, VALPARAISO, IN 46383-2521
(219) 462-7773
(219) 531-5988
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01040290A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000091658
ANTHEM
IN
05
—
100351680B
—
IN
01
—
90000628
IL BC/BS PROVIDER #
IN
Enumeration date
09/21/2006
Last updated
06/05/2015
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