Provider Demographics
NPI:1639172406
Name:WIETING, CHRISTOPHER B (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:B
Last Name:WIETING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:STE B295
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1764
Mailing Address - Country:US
Mailing Address - Phone:859-276-5349
Mailing Address - Fax:859-276-5340
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:STE B295
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1764
Practice Address - Country:US
Practice Address - Phone:859-276-5349
Practice Address - Fax:859-276-5340
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00253213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY800002538Medicaid
KY800002538Medicaid
KY0636901Medicare PIN
KY1325610001Medicare NSC