Provider Demographics
NPI:1689610552
Name:WIELER, MARTIN W (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
Last Name:WIELER
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 1:1220 HEMLOCK WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3650
Mailing Address - Country:US
Mailing Address - Phone:714-545-9441
Mailing Address - Fax:714-545-9486
Practice Address - Street 1:1220 HEMLOCK WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3650
Practice Address - Country:US
Practice Address - Phone:714-545-9441
Practice Address - Fax:714-545-9486
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG301232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG30123AMedicare PIN
A44293Medicare UPIN
CAWG30123RMedicare PIN
CAWG30123GMedicare PIN
CAG30123OMedicare PIN
CAWG30123DMedicare PIN