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General NPI Number Information
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NPI Number | 1104969948
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Entity Type | Organization
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Legal Business Name | GREGORY L. WIEMKEN, DPM, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 15294 PEARL RD
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City | STRONGSVILLE
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State | OH
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Zip | 44136-5021
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Country | US
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Telephone | 440-238-1560
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Fax | 440-238-9091
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Provider Business Mailing Address
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Address Line | 16000 PEARL RD STE 105
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City | STRONGSVILLE
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State | OH
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Zip | 44136-6094
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Country | US
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Telephone | 440-238-1560
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Fax | 440-238-9091
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY WIEMKEN
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Credential | DPM
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Telephone | 440-238-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2702
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License Number State | OH
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