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NPI Code Detail

MEDICARE: MARIJO L WIENKERS MD

MEDICARE: MARIJO L WIENKERS MD
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
1207L00000XAnesthesiology Physician64251AZ
2207LP2900XPain Medicine (Anesthesiology) PhysicianMD60284902WA

General Provider Information

NPI Number : 1225298466
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIJO L WIENKERS MD
Provider Business Mailing Address
First Line : 15705 E OCOTILLO DR
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-5318
Country : US
Telephone Number : 575-649-4527
Fax Number :
Provider Business Practice Location Address
First Line : 15705 E OCOTILLO DR
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-5318
Country : US
Telephone Number : 575-649-4527
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2008
Last Update Date : 03/21/2024

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