Individual
JONATHAN EDWARD WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226
(414) 805-6450
(414) 805-6464
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-6450
(414) 805-6464
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
56819-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689994113
—
WI
Enumeration date
06/07/2010
Last updated
11/30/2023
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