Provider Demographics
NPI:1861019945
Name:WIELAND, MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WIELAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6176
Mailing Address - Country:US
Mailing Address - Phone:309-788-0014
Mailing Address - Fax:309-623-4638
Practice Address - Street 1:612 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6176
Practice Address - Country:US
Practice Address - Phone:309-788-0014
Practice Address - Fax:309-623-4638
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant