MEDICARE: ERIC ALAN WIEBKE 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
1	208600000X	Surgery Physician	1039431A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033176672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC ALAN WIEBKE M.D.

Provider Business Mailing Address
First Line	:	545 BARNHILL DRIVE
Second Line	:	EH 5TH FLOOR UNIVERSITY SURGEONS, INC
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5125
Country	:	US
Telephone Number	:	317-274-4990
Fax Number	:	317-274-0241

Provider Business Practice Location Address
First Line	:	545 BARNHILL DRIVE
Second Line	:	EH 5TH FLOOR UNIVERSITY SURGEONS, INC
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5125
Country	:	US
Telephone Number	:	317-274-3086
Fax Number	:	317-274-0241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/01/2010

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