| 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  |