MEDICARE: ANNIKA VAN WIEREN MD

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	207P00000X	Emergency Medicine Physician	4301509100	MI
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207P00000X	Emergency Medicine Physician	4351046510	MI

General Provider Information

NPI Number	:	1750901658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIKA VAN WIEREN MD

Provider Business Mailing Address
First Line	:	36750 26 MILE ROAD EMERGENCY DEPARTMENT
Second Line	:
City	:	CHESTERFIELD TOWNSHIP
State	:	MI
Zip	:	48047
Country	:	US
Telephone Number	:	865-879-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	36750 26 MILE ROAD EMERGENCY DEPARTMENT
Second Line	:
City	:	CHESTERFIELD TOWNSHIP
State	:	MI
Zip	:	48047
Country	:	US
Telephone Number	:	865-879-2000
Fax Number	:

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

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	06/26/2023

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