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General NPI Number Information
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NPI Number | 1740467000
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Entity Type | Organization
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Legal Business Name | STEVEN WIENER DPM PA
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 1123 MERRITT BLVD
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City | DUNDALK
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State | MD
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Zip | 21222-1438
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Country | US
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Telephone | 410-282-6666
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Fax | 410-282-0357
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Provider Business Mailing Address
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Address Line | 20 CROSSROADS DR SUITE 15
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5419
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Country | US
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Telephone | 410-363-4343
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Fax | 410-356-6373
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIKEL D DANIELS
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Credential |
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Telephone | 410-363-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 01353
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License Number State | MD
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