Provider Demographics
NPI:1073565388
Name:WEIGELT, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:WEIGELT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:TRAUMA SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-8623
Mailing Address - Fax:414-805-8641
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:TRAUMA SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-8623
Practice Address - Fax:414-805-8641
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI339692086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31825900Medicaid
002000329MOtherHUMANA
WI1073565388Medicaid
WI68086 1271Medicare PIN
0067J73601Medicare ID - Type Unspecified
WI31825900Medicaid