Healthcare Provider Details

I. General information

NPI: 1366517419
Provider Name (Legal Business Name): ISIDORO WIENER, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 FROSTWOOD DR SUITE 265
HOUSTON TX
77024-2420
US

IV. Provider business mailing address

5308 HOLLY ST
BELLAIRE TX
77401-4806
US

V. Phone/Fax

Practice location:
  • Phone: 713-785-5007
  • Fax: 713-785-8877
Mailing address:
  • Phone: 713-785-5007
  • Fax: 713-785-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG5769
License Number StateTX

VIII. Authorized Official

Name: DR. ISIDORO WIENER
Title or Position: DIRECTOR
Credential: M.D.
Phone: 713-785-5007