MEDICARE: DR. BRIAN STANLEY WIESZBICKI D.P.M.

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	213E00000X	Podiatrist	PO 2455	FL

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	:	1619986429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN STANLEY WIESZBICKI D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 541209
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32954-1209
Country	:	US
Telephone Number	:	321-453-4628
Fax Number	:

Provider Business Practice Location Address
First Line	:	1834 N ALAFAYA TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4716
Country	:	US
Telephone Number	:	407-627-0062
Fax Number	:	407-674-7346

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	03/05/2023

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