Provider Demographics
NPI:1902843493
Name:WIESE-ROMETSCH, WILHELMINE (MD)
Entity Type:Individual
Prefix:
First Name:WILHELMINE
Middle Name:
Last Name:WIESE-ROMETSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WILHELMINE
Other - Middle Name:
Other - Last Name:WIESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1825 DR MARTIN LUTHER KING WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2525
Practice Address - Country:US
Practice Address - Phone:941-952-4123
Practice Address - Fax:941-952-4101
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077039207R00000X
FLME125719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine