Provider Demographics
NPI:1326243734
Name:WIEGN, PHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PHI
Middle Name:
Last Name:WIEGN
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:PO BOX 453187
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-3187
Mailing Address - Country:US
Mailing Address - Phone:972-566-8388
Mailing Address - Fax:972-566-3481
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-538
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-8388
Practice Address - Fax:972-566-3481
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0307207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199819701Medicaid
TX8F9615Medicare PIN
TXH52323Medicare UPIN