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NPI Code Detail

MEDICARE: DR. JEFFREY C WIENKE JR. DPM CWSP

MEDICARE: DR. JEFFREY C WIENKE JR. DPM CWSP
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
1213E00000XPodiatrist206SD
2213E00000XPodiatrist000820IA
3213ES0103XFoot & Ankle Surgery Podiatrist345NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
147-0836558OTHERNETAX ID

General Provider Information

NPI Number : 1629207261
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY C WIENKE JR. DPM CWSP
Provider Business Mailing Address
First Line : 1150 N 83RD ST
Second Line :
City : LINCOLN
State : NE
Zip : 68505-2094
Country : US
Telephone Number : 402-483-4485
Fax Number :
Provider Business Practice Location Address
First Line : 1150 N 83RD ST
Second Line :
City : LINCOLN
State : NE
Zip : 68505-2094
Country : US
Telephone Number : 402-483-4485
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2009
Last Update Date : 08/16/2017

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