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NPI Code Detail

MEDICARE: DR. GREGORY L WIEDEL M.D.

MEDICARE: DR. GREGORY L WIEDEL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician3959SD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110105454OTHERSDRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10003961OTHERSDWELLMARK
33959OTHERSDDAKOTACARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033114871
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY L WIEDEL M.D.
Provider Business Mailing Address
First Line : PO BOX 1411
Second Line :
City : HURON
State : SD
Zip : 57350-1411
Country : US
Telephone Number : 605-352-8767
Fax Number : 605-352-8784
Provider Business Practice Location Address
First Line : 455 KANSAS AVE SE
Second Line :
City : HURON
State : SD
Zip : 57350-2522
Country : US
Telephone Number : 605-352-8767
Fax Number : 605-352-8784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 11/03/2009

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