Healthcare Provider Details

I. General information

NPI: 1902843493
Provider Name (Legal Business Name): WILHELMINE WIESE-ROMETSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WILHELMINE WIESE MD

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 DR MARTIN LUTHER KING WAY
SARASOTA FL
34234-2525
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-952-4123
  • Fax: 941-952-4101
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301077039
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME125719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: