Individual
TIMOTHY E. WIESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9470 BROADWAY, CROWN POINT, IN 46307-5722
(219) 661-3260
(219) 662-3765
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01049993A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000721937
ANTHEM TRADITIONAL
IN
05
—
200231320
—
IN
Enumeration date
07/09/2006
Last updated
09/28/2023
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