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General NPI Number Information
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NPI Number | 1720145584
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Entity Type | Organization
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Legal Business Name | WIECK MEDICAL MANAGEMENT PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2401 W WRANGLER BLVD
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City | SEMINOLE
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State | OK
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Zip | 74868-1917
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Country | US
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Telephone | 405-303-4167
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 652
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City | HOLDENVILLE
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State | OK
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Zip | 74848-0652
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER-OPERATOR
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Name | DR. ROBERT ALLEN WIECK
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Credential | DO
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Telephone | 405-303-4167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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