Provider Demographics
NPI:1801188792
Name:WIEGEL, MICAH DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:DAVID
Last Name:WIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:625 UNITED DR STE 420
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-7810
Mailing Address - Country:US
Mailing Address - Phone:501-358-6941
Mailing Address - Fax:501-358-6951
Practice Address - Street 1:625 UNITED DR STE 420
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7810
Practice Address - Country:US
Practice Address - Phone:501-358-6941
Practice Address - Fax:501-358-6951
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9098207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology