Active NPI
Karl Fredric Wieneke Jr., M.D.
- Surgery Physician
- Poland, OH
National Provider Identifier
1639448855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 35. 030684
- Practice address
- 36 Audubon Rd
Poland, OH 44514-1924 - Phone
- (330) 757-3650
- NPI assigned
- Dec 16, 2011
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 35. 030684 | OH | Primary |
Addresses
Primary practice location
36 Audubon Rd
Poland, OH 44514-1924
Mailing address
36 Audubon Rd
Poland, OH 44514-1924
Phone (330) 757-3650
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 |
|---|---|---|---|
| 35. 030684 | OH | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323993600000",
"number": "1639448855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 AUDUBON RD",
"city": "POLAND",
"state": "OH",
"postal_code": "445141924",
"telephone_number": "330-757-3650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 AUDUBON RD",
"city": "POLAND",
"state": "OH",
"postal_code": "445141924",
"telephone_number": "330-757-3650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIENEKE",
"first_name": "KARL",
"middle_name": "FREDRIC",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-16",
"last_updated": "2011-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OH",
"license": "35. 030684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.