Healthcare Provider Details

I. General information

NPI: 1770805491
Provider Name (Legal Business Name): JULIE A WIEGER DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 S MICHIGAN ST
SOUTH BEND IN
46614
US

IV. Provider business mailing address

3506 S MICHIGAN ST
SOUTH BEND IN
46614-1728
US

V. Phone/Fax

Practice location:
  • Phone: 574-231-1960
  • Fax: 574-231-1961
Mailing address:
  • Phone: 574-231-1960
  • Fax: 574-231-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberIN07000810
License Number StateIN

VIII. Authorized Official

Name: MRS. JULIE A WIEGER
Title or Position: BUSINESS OWNER
Credential: DPM
Phone: 574-231-1960