Provider Demographics
NPI:1881663847
Name:BIRKHOLTZ-WIER, MARLENE S (DO)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:S
Last Name:BIRKHOLTZ-WIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:S
Other - Last Name:BIRKHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:220 ESSIE DAVISON DR.
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2915
Mailing Address - Country:US
Mailing Address - Phone:712-542-2176
Mailing Address - Fax:712-542-8311
Practice Address - Street 1:220 ESSIE DAVISON DR
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2915
Practice Address - Country:US
Practice Address - Phone:712-542-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE349208600000X
IA38630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470767637-13Medicaid
NENA1456004Medicare PIN
NE276709Medicare PIN
H11342Medicare UPIN
C807631Medicare PIN