Individual
MARTIN F WIESCHHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 E DOUGLAS RD, STE 407, MISHAWAKA, IN 46545-1464
(574) 335-6500
(574) 335-0772
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036210A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100325860
—
IN
01
—
1102246243
ANTHEM
IN
Enumeration date
06/11/2006
Last updated
11/09/2023
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