Provider Demographics
NPI:1942244660
Name:WIEGER, JULIE A (DPM FAC FAS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:WIEGER
Suffix:
Gender:F
Credentials:DPM FAC FAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 S MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1728
Mailing Address - Country:US
Mailing Address - Phone:574-231-1960
Mailing Address - Fax:574-231-1961
Practice Address - Street 1:3506 S MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-1728
Practice Address - Country:US
Practice Address - Phone:574-231-1960
Practice Address - Fax:574-231-1961
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000810213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5082570001Medicare NSC
INU58066Medicare UPIN
IN237810Medicare PIN