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General NPI Number Information
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NPI Number | 1831187087
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Entity Type | Individual
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Provider Name | RICHARD M WIECEK MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1479 N RIVER RD STE 120
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City | FREMONT
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State | OH
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Zip | 43420-9760
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Country | US
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Telephone | 419-559-2814
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Fax | 419-355-8490
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Provider Business Mailing Address
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Address Line | PO BOX 378
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City | SANDUSKY
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State | OH
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Zip | 44871-0378
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Country | US
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Telephone | 419-609-1112
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Fax | 419-609-1123
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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 | 35084364
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License Number State | OH
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