MEDICARE: DR. HARVEY R WIESELTIER 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	207X00000X	Orthopaedic Surgery Physician	G50193	CA

General Provider Information

NPI Number	:	1649342726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARVEY R WIESELTIER M.D.

Provider Business Mailing Address
First Line	:	3500 5TH AVE
Second Line	:	SUITE 106
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5053
Country	:	US
Telephone Number	:	619-294-8459
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 5TH AVE
Second Line	:	SUITE 106
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5053
Country	:	US
Telephone Number	:	619-294-8459
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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