Provider Demographics
NPI:1104969609
Name:WIEMKEN, GREGORY L (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:WIEMKEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16000 PEARL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6094
Mailing Address - Country:US
Mailing Address - Phone:440-238-1560
Mailing Address - Fax:440-238-9091
Practice Address - Street 1:15294 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5021
Practice Address - Country:US
Practice Address - Phone:440-238-1560
Practice Address - Fax:440-238-9091
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH2702213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0827109Medicaid
OH480029644OtherRAILROAD MEDICARE
OH480029644OtherRAILROAD MEDICARE
OHU19178Medicare UPIN