Wiese, Kim Keith

Wiese, Kim Keith is an individual health care provider with primary practice located at 1524 W Glen Ave , Peoria IL 61614-4692. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Wiese, Kim Keith can be contacted via phone (309) 512-0902.

Contact Information

Primary practice address
1524 W Glen Ave Peoria IL 61614-4692
Phone: (309) 512-0902
Fax: (094) 030-3973
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085.006503 Illinois

Profile Details

NPI number 1801866744
LBN Legal business name Wiese, Kim Keith
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2006
Last updated May 19th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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