Provider Demographics
NPI:1366517419
Name:ISIDORO WIENER, M.D., P.A.
Entity type:Organization
Organization Name:ISIDORO WIENER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIDORO
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-785-5007
Mailing Address - Street 1:5308 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4806
Mailing Address - Country:US
Mailing Address - Phone:713-785-5007
Mailing Address - Fax:713-785-8877
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:SUITE 265
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-785-5007
Practice Address - Fax:713-785-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX98PUOtherBCBS
TX00396WMedicare PIN
TXC23461Medicare UPIN