Provider Demographics
NPI:1457353294
Name:WIENER, ISIDORO (MD)
Entity type:Individual
Prefix:DR
First Name:ISIDORO
Middle Name:
Last Name:WIENER
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 1:902 FROSTWOOD DR
Mailing Address - Street 2:265
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-785-5007
Mailing Address - Fax:713-785-8877
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:265
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-785-5007
Practice Address - Fax:713-785-8877
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5769208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AD967OtherBCBS
TXC23461Medicare UPIN
TX8AD967OtherBCBS