Mark A Wiechert, MD | |
1707 N Henderson St, Galesburg, IL 61401-1320 | |
(309) 343-1000 | |
(309) 344-1054 |
Full Name | Mark A Wiechert |
---|---|
Gender | Male |
Speciality | Emergency Medicine |
Location | 1707 N Henderson St, Galesburg, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1063513893 | NPI | - | NPPES |
5471051 | Other | AETNA | |
4815127 | Other | BC/BS | |
11054102 | Other | CAQH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | (Illinois) | Primary |
Entity Name | St Mary Medical Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1962467670 PECOS PAC ID: 8628038015 Enrollment ID: O20041011000420 |
Entity Name | Osf Multi-specialty Group |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1922445527 PECOS PAC ID: 3678889789 Enrollment ID: O20150904000279 |
Mailing Address | Practice Location Address |
---|---|
Mark A Wiechert, MD 1707 N Henderson St, Galesburg, IL 61401-1320 Ph: (309) 343-1000 | Mark A Wiechert, MD 1707 N Henderson St, Galesburg, IL 61401-1320 Ph: (309) 343-1000 |
Fares Aris, Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 3333 N Seminary St, Galesburg, IL 61401 Phone: 309-344-3161 | |
Dr. Justin Hering, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 3333 N Seminary St, Galesburg, IL 61401 Phone: 309-344-9403 | |
Ernest Vesta, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 695 N Kellogg St, Galesburg, IL 61401 Phone: 309-343-8131 Fax: 309-343-2393 | |
Veerasikku Bommiasamy, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 695 N Kellogg St, Galesburg, IL 61401 Phone: 309-343-8131 | |
Martin Musuruana, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 3333 N Seminary St, Galesburg, IL 61401 Phone: 309-344-3161 | |
Dr. Ronald J Wiechert, MD, PHD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 3333 N Seminary St, Galesburg, IL 61401 Phone: 309-344-9403 |