Provider Demographics
NPI:1740281708
Name:WIEGAND, MADELYN CLAIRE (MD)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:CLAIRE
Last Name:WIEGAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 GAUSE BLVD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4235
Mailing Address - Country:US
Mailing Address - Phone:985-259-4318
Mailing Address - Fax:985-259-4153
Practice Address - Street 1:2250 GAUSE BLVD E
Practice Address - Street 2:SUITE 200
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4235
Practice Address - Country:US
Practice Address - Phone:985-259-4318
Practice Address - Fax:985-259-4153
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.019971207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism