Provider Demographics
NPI:1104805837
Name:WIECHMANN, MICHAEL L (MD, FACC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:WIECHMANN
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:295 POSADA LN STE A
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4055
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58530207RC0000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28458ZOtherBLUE SHIELD
CA60033859OtherRR MEDICARE
CAGR0068680Medicaid
CAZZZ28458ZOtherBLUE SHIELD
CAWG58530JMedicare PIN
CA060033859Medicare PIN
CA60033859OtherRR MEDICARE
CAWG58530BMedicare PIN
CAWG58530CMedicare PIN
CAGR0068680Medicaid
CAWG58530DMedicare PIN
CAWG58530HMedicare PIN
CAWG58530IMedicare PIN
CAWG58530MMedicare PIN