Provider Demographics
NPI:1558456244
Name:WIEMAN, THOMAS JEFFERY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFERY
Last Name:WIEMAN
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 1:4321 WASHINGTON ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5961
Mailing Address - Country:US
Mailing Address - Phone:816-932-4549
Mailing Address - Fax:816-932-5793
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-932-4549
Practice Address - Fax:816-932-5793
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028235208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
L76D098Medicare ID - Type Unspecified