Provider Demographics
NPI:1356449771
Name:WIELE, ROBERT D (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:WIELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2636
Mailing Address - Country:US
Mailing Address - Phone:314-821-6471
Mailing Address - Fax:
Practice Address - Street 1:2 PROGRESS POINT CT
Practice Address - Street 2:PROGRESS WEST HEALTH CENTER
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2208
Practice Address - Country:US
Practice Address - Phone:314-740-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9840207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201593613Medicaid
MO964095198Medicare PIN
MO042050166Medicare PIN
E65951Medicare UPIN
MO964095005Medicare PIN
MO042050166Medicare ID - Type Unspecified