Individual
DR. JOHN M. WIELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1505 EASTLAND DR, SUITE 2300, BLOOMINGTON, IL 61701-3534
(309) 662-9022
(309) 662-2091
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036078215
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036078215
PUBLIC AID
ID
01
—
05700305
BLUE CROSS BLUE SHIELD
IL
01
—
833120
MEDICARE GROUP #
—
Enumeration date
07/06/2006
Last updated
12/07/2020
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