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General NPI Number Information
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NPI Number | 1487870796
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Entity Type | Organization
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Legal Business Name | CRAIG W. WIESENHUTTER, MD
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 950 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2644
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Country | US
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Telephone | 208-765-5457
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Fax | 208-765-6248
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Provider Business Mailing Address
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Address Line | 950 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2644
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Country | US
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Telephone | 208-765-5457
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Fax | 208-765-6248
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Authorized Official
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Title or Position | OWNER
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Name | DR. CRAIG W WIESENHUTTER
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Credential | M.D.
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Telephone | 208-765-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | M4720
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License Number State | ID
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