Individual
MARTIN WIESENFELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.P.
Contact information
Practice address
701 10TH ST SE, HPCC 3RD FLOOR, CEDAR RAPIDS, IA 52403-1251
(319) 363-8303
(319) 364-4659
Mailing address
701 10TH ST SE, HPCC 3RD FLOOR, CEDAR RAPIDS, IA 52403-1251
(319) 363-8303
(319) 364-4659
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
20679
IA
207RX0202X
Medical Oncology Physician
Primary
20679
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0163055
—
IA
01
—
110045771
RAILROAD MEDICARE
IA
01
—
16305
WELLMARK BC/BS
IA
Enumeration date
12/14/2005
Last updated
04/30/2012
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