Provider Demographics
NPI:1588610661
Name:WIESE, JAMES ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
Last Name:WIESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2771 OAKDALE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9747
Mailing Address - Country:US
Mailing Address - Phone:319-545-7310
Mailing Address - Fax:319-626-7314
Practice Address - Street 1:2769 HEARTLAND DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-545-7300
Practice Address - Fax:319-545-7314
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA245752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0057497Medicaid
IA0081794Medicaid
IA27997OtherBLUE CROSS BLUE SHIELD
IA32811OtherBLUE CROSS BLUE SHIELD
IA3081794Medicaid
IA19476OtherBLUE CROSS BLUE SHIELD
IA42859OtherBLUE CROSS BLUE SHIELD
IA27997OtherBLUE CROSS BLUE SHIELD