Active NPI
Harald J.a. Wiedemann, M.D.
- Anesthesiology Physician
- Ketchum, ID
National Provider Identifier
1619103249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- M-2626
- Practice address
- 114 Deer Run Rd.
Ketchum, ID 83340-2290 - Phone
- (208) 726-5592
- Fax
- (208) 726-5592
- NPI assigned
- Jun 10, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | M-2626 | ID | Primary |
Addresses
Primary practice location
114 Deer Run Rd.
Ketchum, ID 83340-2290
Mailing address
PO Box 2290
Ketchum, ID 83340-2290
Phone (208) 726-5592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-2626 | ID | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391126400000",
"number": "1619103249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2290",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833402290",
"telephone_number": "208-726-5592",
"fax_number": "208-726-5592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 DEER RUN RD.",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833402290",
"telephone_number": "208-726-5592",
"fax_number": "208-726-5592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDEMANN",
"first_name": "HARALD",
"middle_name": "J.A.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-10",
"last_updated": "2014-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "ID",
"license": "M-2626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ketchum, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.