Provider Demographics
NPI:1568453553
Name:WIEST, KARYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:M
Last Name:WIEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7154
Mailing Address - Country:US
Mailing Address - Phone:407-381-7345
Mailing Address - Fax:407-636-7820
Practice Address - Street 1:7416 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7154
Practice Address - Country:US
Practice Address - Phone:407-381-7345
Practice Address - Fax:407-636-7820
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262083900Medicaid
FL262083900Medicaid