Individual
DR. ALLISON JANE WIESMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01066799A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11013113A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000617054
ANTHEM PIN NUMBER
IN
01
—
200311740E
MEDICAID GROUP NUMBER
IN
05
—
200945360
—
IN
01
—
208000000X
TAXONOMY CODE
IN
Enumeration date
05/26/2007
Last updated
02/01/2011
Update your record
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