MEDICARE: DR. SCOTT L WIESEN 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	207RG0100X	Gastroenterology Physician	ME0053124	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	:	1831130814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT L WIESEN MD

Provider Business Mailing Address
First Line	:	625 9TH ST N
Second Line	:	SUITE 304
City	:	NAPLES
State	:	FL
Zip	:	34102-8143
Country	:	US
Telephone Number	:	239-775-4444
Fax Number	:	239-775-4445

Provider Business Practice Location Address
First Line	:	625 9TH ST N
Second Line	:	SUITE 304
City	:	NAPLES
State	:	FL
Zip	:	34102-8143
Country	:	US
Telephone Number	:	239-775-4444
Fax Number	:	239-775-4445

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	10/16/2013

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Directions to “ DR. SCOTT L WIESEN MD” Practice Location

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