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NPI Code Detail

MEDICARE: GEORGE THOMAS WIEDENHOEFT LMSW

MEDICARE: GEORGE THOMAS WIEDENHOEFT LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801019491MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1982471010011OTHERPREFERRED ONE
2GW019491OTHERMIBCBS OF MI

General Provider Information

NPI Number : 1881638617
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE THOMAS WIEDENHOEFT LMSW
Provider Business Mailing Address
First Line : 715 PYLE DR
Second Line :
City : KINGSFORD
State : MI
Zip : 49802-4456
Country : US
Telephone Number : 906-774-0522
Fax Number : 906-774-1570
Provider Business Practice Location Address
First Line : 715 PYLE DR
Second Line :
City : KINGSFORD
State : MI
Zip : 49802-4456
Country : US
Telephone Number : 906-774-0522
Fax Number : 906-774-1570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 07/08/2007

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1134163439 — LISA MARIE DUCA RN
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49802-4456
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1255376018 — GINA MARIE BILSKI RN
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