Provider Demographics
NPI:1083806608
Name:WIERSEMA, MARGARITA ARKADIY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:ARKADIY
Last Name:WIERSEMA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 LAFAYETTE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1147
Mailing Address - Country:US
Mailing Address - Phone:317-291-7422
Mailing Address - Fax:317-291-4912
Practice Address - Street 1:3400 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1146
Practice Address - Country:US
Practice Address - Phone:317-298-0025
Practice Address - Fax:317-291-7433
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01067235A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200990710Medicaid