Provider Demographics
NPI:1942280920
Name:WIERMAN, JAMES LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:WIERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-0378
Mailing Address - Country:US
Mailing Address - Phone:269-782-2111
Mailing Address - Fax:269-782-9852
Practice Address - Street 1:400 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1704
Practice Address - Country:US
Practice Address - Phone:269-782-2111
Practice Address - Fax:269-782-9852
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1371059Medicaid
MI9140001OtherBLUE CROSS BLUE SHIELD
MI233904OtherMEDICARE RURAL HEALTH
MICL2379OtherMEDICARE RAILROAD
MIN93000001Medicare ID - Type Unspecified
MI233904Medicare PIN
MI9140001OtherBLUE CROSS BLUE SHIELD
MI233904Medicare Oscar/Certification