MEDICARE: DR. JANET S WIESELTHIER M.D.

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	207ND0900X	Dermatopathology Physician	35.070376	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070012438	OTHER	OH	RAILROAD MEDICARE NUMBER
4	9186053	OTHER	OH	GROUP MEDICARE LEGACY NUM
5	9186052	OTHER	OH	MEDICARE GROUP LEGACY NUM

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
2	1154487932	OTHER	OH	GROUP NPI

General Provider Information

NPI Number	:	1639174386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET S WIESELTHIER M.D.

Provider Business Mailing Address
First Line	:	29001 CEDAR RD
Second Line	:	SUITE 203
City	:	LYNDHURST
State	:	OH
Zip	:	44124-4062
Country	:	US
Telephone Number	:	440-684-9933
Fax Number	:	440-684-9971

Provider Business Practice Location Address
First Line	:	29001 CEDAR RD
Second Line	:	SUITE 203
City	:	LYNDHURST
State	:	OH
Zip	:	44124-4062
Country	:	US
Telephone Number	:	440-684-9933
Fax Number	:	440-684-9971

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

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	08/02/2012

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Directions to “ DR. JANET S WIESELTHIER M.D.” Practice Location

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