Provider Demographics
NPI:1548584626
Name:FRANK J WIERICHS MD PA
Entity type:Organization
Organization Name:FRANK J WIERICHS MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIERICHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-484-3234
Mailing Address - Street 1:420 TAMIAMI TRL S
Mailing Address - Street 2:STE 302
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2620
Mailing Address - Country:US
Mailing Address - Phone:941-484-3234
Mailing Address - Fax:941-484-3250
Practice Address - Street 1:420 TAMIAMI TRL S
Practice Address - Street 2:STE 302
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2620
Practice Address - Country:US
Practice Address - Phone:941-484-3234
Practice Address - Fax:941-484-3250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANK J WIERICHS MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-18
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19705174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79177Medicare PIN
FLD58680Medicare UPIN