Individual
RICHARD JOEL WEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3625 PARK PL W, STE 100, MISHAWAKA, IN 46545-3561
(574) 232-5963
(574) 287-7988
Mailing address
3625 PARK PL W, STE 100, MISHAWAKA, IN 46545-3561
(574) 232-5963
(574) 287-7988
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01034947
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086629
BLUE CROSS BLUE SHIELD
IN
05
—
100090000A
—
IN
Enumeration date
11/04/2005
Last updated
12/28/2010
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