Provider Demographics
NPI:1386980738
Name:CARLOS E WIEGERING MD PA
Entity type:Organization
Organization Name:CARLOS E WIEGERING MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MD
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIEGERING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-858-4366
Mailing Address - Street 1:3661 S. MIAMI AVENUE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133
Mailing Address - Country:US
Mailing Address - Phone:305-858-4366
Mailing Address - Fax:305-858-4365
Practice Address - Street 1:3661 S. MIAMI AVENUE
Practice Address - Street 2:SUITE 710
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-858-4366
Practice Address - Fax:305-858-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066713208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty