MEDICARE: DR. JOHN CALLAWAY WILTSIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0000X	Hematology (Internal Medicine) Physician	16135	MN

General Provider Information

NPI Number	:	1154578912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CALLAWAY WILTSIE M.D.

Provider Business Mailing Address
First Line	:	4554 CORNWALL DR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-3423
Country	:	US
Telephone Number	:	507-289-0151
Fax Number	:

Provider Business Practice Location Address
First Line	:	4554 CORNWALL DR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-3423
Country	:	US
Telephone Number	:	507-289-0151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2008
Last Update Date	:	08/24/2008

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