| Alexis Wiesenthal Md Pa | |
|
8038 Wurzbach Rd Ste 320 San Antonio TX 78229-3813 | |
| (210) 614-3365 | |
| Not Available |
| Full Name | Alexis Wiesenthal Md Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 8038 Wurzbach Rd Ste 320, San Antonio, Texas |
| Authorized Official Name and Position | Alexis Wiesenthal (PRESIDENT) |
| Authorized Official Contact | 2108573767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alexis Wiesenthal Md Pa Po Box 6627 San Antonio TX 78209-0627 Ph: () - | Alexis Wiesenthal Md Pa 8038 Wurzbach Rd Ste 320 San Antonio TX 78229-3813 Ph: (210) 614-3365 |
| NPI Number | 1003175662 |
|---|---|
| Provider Enumeration Date | 05/16/2012 |
| Last Update Date | 05/16/2012 |
| Medicare PECOS PAC ID | 9133385412 |
|---|---|
| Medicare Enrollment ID | O20120801000272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003175662 | NPI | - | NPPES |
| 8F9634 | Other | TX | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | N1219 (Texas) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | N1219 (Texas) | Primary |
| Provider Name | Alexis A Wiesenthal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881663557 PECOS PAC ID: 3072676360 Enrollment ID: I20090113000490 |
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