Provider Demographics
NPI:1619438629
Name:WIEMANN, BRIANNE (MD)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:WIEMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE STE 301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3668
Practice Address - Country:US
Practice Address - Phone:505-727-7096
Practice Address - Fax:505-727-7099
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2019-0414390200000X
MI4301510690208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2025-0068OtherSTATE LICENSE