| 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 |
Dr. Caleb W Milius, DO Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 3333 N Seminary St, Galesburg, IL 61401 Phone: 309-344-3161 Fax: 309-344-9448 | |
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: Not Enrolled in Medicare 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 |