MEDICARE: DR. CARLOS E WIEGERING PHYSICIAN/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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	ME0066713	FL

General Provider Information

NPI Number	:	1265591580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS E WIEGERING PHYSICIAN/MD

Provider Business Mailing Address
First Line	:	3661 S MIAMI AVENUE
Second Line	:	SUITE 710
City	:	MIAMI
State	:	FL
Zip	:	33133
Country	:	US
Telephone Number	:	305-858-4366
Fax Number	:	305-858-4365

Provider Business Practice Location Address
First Line	:	240 CRANDON BLVD
Second Line	:	SUITE 115
City	:	KEY BISCAYNE
State	:	FL
Zip	:	33149-1543
Country	:	US
Telephone Number	:	305-365-0444
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/19/2020

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