Provider Demographics
NPI:1154572972
Name:DAVID A. WIERSEMA, D.O., PLLC
Entity type:Organization
Organization Name:DAVID A. WIERSEMA, D.O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIERSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-797-4610
Mailing Address - Street 1:4701 TOWNE CTR
Mailing Address - Street 2:STE. 102
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2834
Mailing Address - Country:US
Mailing Address - Phone:989-797-4610
Mailing Address - Fax:989-797-4612
Practice Address - Street 1:4701 TOWNE CTR
Practice Address - Street 2:STE. 102
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2834
Practice Address - Country:US
Practice Address - Phone:989-797-4610
Practice Address - Fax:989-797-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty