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General NPI Number Information
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NPI Number | 1598184731
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Entity Type | Individual
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Provider Name | GEORG KRISTOFER WIESE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 34509 9TH AVE S STE 204
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8708
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Country | US
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Telephone | 253-835-5510
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Fax | 253-835-5511
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Provider Business Mailing Address
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Address Line | 34509 9TH AVE S STE 204
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8708
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Country | US
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Telephone | 253-835-5510
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Fax | 253-835-5511
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME128351
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD61684844
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License Number State | WA
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