Provider Demographics
NPI:1063681260
Name:WIEMER FAMILY PODIATRY, LLC
Entity Type:Organization
Organization Name:WIEMER FAMILY PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:484-453-8164
Mailing Address - Street 1:850 W CHESTER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4400
Mailing Address - Country:US
Mailing Address - Phone:484-453-8164
Mailing Address - Fax:484-453-8291
Practice Address - Street 1:850 W CHESTER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4400
Practice Address - Country:US
Practice Address - Phone:484-453-8164
Practice Address - Fax:484-453-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004761L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00018271290002Medicaid
PA121558Medicare PIN
PA00018271290002Medicaid