Provider Demographics
NPI:1639174386
Name:WIESELTHIER, JANET S (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:S
Last Name:WIESELTHIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29001 CEDAR RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4062
Mailing Address - Country:US
Mailing Address - Phone:440-684-9933
Mailing Address - Fax:440-684-9971
Practice Address - Street 1:29001 CEDAR RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4062
Practice Address - Country:US
Practice Address - Phone:440-684-9933
Practice Address - Fax:440-684-9971
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-18
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.070376207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2087352Medicaid
OH1154487932OtherGROUP NPI
OH070012438OtherRAILROAD MEDICARE NUMBER
OH9186053OtherGROUP MEDICARE LEGACY NUM
OH9186052OtherMEDICARE GROUP LEGACY NUM
OHWI0810226Medicare PIN
OHB27563Medicare UPIN
OHWI0810227Medicare PIN