Provider Demographics
NPI:1598822124
Name:WESSELMAN, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WESSELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8585 CRITERION DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1045
Mailing Address - Country:US
Mailing Address - Phone:303-335-9742
Mailing Address - Fax:303-265-9457
Practice Address - Street 1:700 E SPEER BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203
Practice Address - Country:US
Practice Address - Phone:303-335-9742
Practice Address - Fax:303-265-9457
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91347207R00000X
CODR.0056888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BW1080592OtherDEA