Healthcare Provider Details

I. General information

NPI: 1306953187
Provider Name (Legal Business Name): MICHAEL WIEMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD SUITE #324
INDIANAPOLIS IN
46260-2074
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-3708
  • Fax:
Mailing address:
  • Phone: 317-802-3116
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01037480
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: