Provider Demographics
NPI:1194783761
Name:WIENER, HARVEY M (DO)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:M
Last Name:WIENER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ASHLEY DR
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5304
Mailing Address - Country:US
Mailing Address - Phone:813-899-6223
Mailing Address - Fax:813-984-7192
Practice Address - Street 1:100 S ASHLEY DR
Practice Address - Street 2:SUITE 600
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5304
Practice Address - Country:US
Practice Address - Phone:813-899-6223
Practice Address - Fax:813-984-7192
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 86682085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7049OtherHEALTHNET
AZ470001313OtherRAILRD MEDICARE
AZAZ0324990OtherBCBS
AZ312398OtherAHCCCS
AZAZ0324990OtherBCBS
AZ470001313OtherRAILRD MEDICARE
AZZ114901Medicare PIN