Barbara May Wieties-Malm, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036068572 Issued in IL

Practice address

12935 Gregory St
Blue Island, IL 60406-2428

Phone

(708) 597-2000

NPI assigned

Jan 9, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1699753780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 127TH ST",
            "address_2": "2ND FLOOR",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604063802",
            "telephone_number": "708-388-0423",
            "fax_number": "708-388-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12935 GREGORY ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062428",
            "telephone_number": "708-597-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETIES-MALM",
        "first_name": "BARBARA",
        "middle_name": "MAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-09",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036068572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PIN",
            "identifier": "01615363",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036068572",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Palmer Wardlaw, RN,APN
• Julia Wegmann, MSW, LSW
• Anthony West
• Takenya White
• Wholistic Healthcare Services, Inc.
• Sarah L Williams
• Shirley Vernetha Willis III, REGISTERED NURSE
• Alma Wingard
• Scott Charles Wirtanen, PHARMD
• Debra Witt, PT

• Diagnostic Radiology Physician in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.