Individual
CHAD A WIESENAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
234 E GRAY ST, LOUISVILLE, KY 40202-1900
(502) 588-0390
(502) 584-5437
Mailing address
234 E GRAY ST, LOUISVILLE, KY 40202-1900
(502) 588-0390
(502) 584-5437
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
01053500A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01053500A
STATE LICENSE NUMBER
IN
05
—
7100008600
—
KY
Enumeration date
04/12/2007
Last updated
10/09/2017
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