MR. Kim Keith Wiese, PA-C

NPI #1801866744 in Peoria, Illinois

Provider Information

NPI Number: 1801866744
Entity Type: Individual
Name: MR. Kim Keith Wiese, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Jan 24, 2006
Last Updated: May 19, 2020

Practice Location

Address: 1524 W GLEN AVE
City: Peoria
State: Illinois
ZIP Code: 61614-4692
Phone: (309) 512-0902

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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