Provider Demographics
NPI:1861493967
Name:WESNER, COREY W (DPM)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:W
Last Name:WESNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4638
Mailing Address - Country:US
Mailing Address - Phone:920-725-4008
Mailing Address - Fax:920-725-4218
Practice Address - Street 1:1440 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4638
Practice Address - Country:US
Practice Address - Phone:920-725-4008
Practice Address - Fax:920-725-4218
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI759-025213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU68663Medicare UPIN
WI4897890001Medicare NSC