Most Relevant Information
Provider Data
| NPI Number: | 1003348343 |
| Provider Name: | MICHELLE ELISE WIESE MD |
| Entity Type: | Individual |
| Taxonomy Code: | 2084P0800X |
| Specialty: | Psychiatry & Neurology |
| License Number: | MD60988236 |
Most Important Dates
| Enumeration Date: | 03/28/2017 |
| Last Updated: | 06/28/2024 |
Provider Practice Location
909 E STATE BLVD
FORT WAYNE
IN
468053404
Practice Location Phone/Fax
| Phone: | 2604812700 |
| Fax: | 2604812838 |
Provider Mailing Location
11109 PARKVIEW PLAZA DR # 117
FORT WAYNE
IN
468451701
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |
Suggested EMR
Psychiatry EMR