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NPI Code Detail

MEDICARE: J PAUL WIESNER & ASSOCIATES CHARTERED

MEDICARE: J PAUL WIESNER & ASSOCIATES CHARTERED
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
12085N0700XNeuroradiology Physician
22085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2NV4864OTHERNVBCBS NV
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487606026
Entity Type Code : Organization
Provider Name (Legal Business Name) : J PAUL WIESNER & ASSOCIATES CHARTERED
Provider Business Mailing Address
First Line : PO BOX 30077
Second Line : DEPT 305
City : SALT LAKE CITY
State : UT
Zip : 84130-0077
Country : US
Telephone Number : 855-865-4435
Fax Number :
Provider Business Practice Location Address
First Line : 5495 S RAINBOW BLVD STE 203
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-1873
Country : US
Telephone Number : 702-477-0772
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MICAH K NIELSEN
Credential : M.D.
Telephone Number : 702-477-0772
Provider Enumeration Date : 05/16/2006
Last Update Date : 06/28/2023

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Directions to “J PAUL WIESNER & ASSOCIATES CHARTERED ” Practice Location

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