Healthcare Provider Details

I. General information

NPI: 1861493967
Provider Name (Legal Business Name): COREY W WESNER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 S COMMERCIAL ST
NEENAH WI
54956-4638
US

IV. Provider business mailing address

1440 S COMMERCIAL ST
NEENAH WI
54956-4638
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-4008
  • Fax: 920-725-4218
Mailing address:
  • Phone: 920-725-4008
  • Fax: 920-725-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number759-025
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number759-025
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: