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General NPI Number Information
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NPI Number | 1740265404
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Entity Type | Individual
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Provider Name | MARTIN WIESENFELD M.D., F.A.C.P.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 701 10TH ST SE HPCC 3RD FLOOR
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-1251
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Country | US
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Telephone | 319-363-8303
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Fax | 319-364-4659
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Provider Business Mailing Address
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Address Line | 701 10TH ST SE HPCC 3RD FLOOR
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-1251
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Country | US
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Telephone | 319-363-8303
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Fax | 319-364-4659
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 20679
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 20679
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License Number State | IA
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