Jon D Wiese, MD | |
521 W State Road 434, Suite 301, Longwood, FL 32750-5166 | |
(407) 767-5808 | |
(407) 767-5892 |
Full Name | Jon D Wiese |
---|---|
Gender | Male |
Speciality | Surgery |
Location | 521 W State Road 434, Longwood, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1952474561 | NPI | - | NPPES |
ME54060 | Other | FL | MEDICAL LICENSE |
049597200 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208600000X | Surgery | ME54060 (Florida) | Primary |
Entity Name | Orlando Health Medical Group Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1669429577 PECOS PAC ID: 9537059084 Enrollment ID: O20040318000044 |
Mailing Address | Practice Location Address |
---|---|
Jon D Wiese, MD 521 W State Road 434, Suite 301, Longwood, FL 32750-5166 Ph: (407) 767-5808 | Jon D Wiese, MD 521 W State Road 434, Suite 301, Longwood, FL 32750-5166 Ph: (407) 767-5808 |
Kristin L Wulff, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 295 W Pine Ave, Longwood, FL 32750 Phone: 407-339-4499 Fax: 407-339-4903 | |
Jessica M Gielow, D.O. Surgery Medicare: Accepting Medicare Assignments Practice Location: 521 W State Road 434 Ste 301, Longwood, FL 32750 Phone: 407-767-5808 Fax: 407-767-5892 | |
Natalee Genevieve Stone, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 521 W State Road 434 Ste 301, Longwood, FL 32750 Phone: 407-767-5808 Fax: 407-767-5892 |