MEDICARE: DR. DANIEL JOSEPH WILTZ 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	207Q00000X	Family Medicine Physician	023274	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184644254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JOSEPH WILTZ M.D.

Provider Business Mailing Address
First Line	:	111 COACHMAN DR
Second Line	:	J
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-5239
Country	:	US
Telephone Number	:	337-839-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 N MAIN ST
Second Line	:	SUITE B
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3513
Country	:	US
Telephone Number	:	337-394-7111
Fax Number	:	337-394-8105

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	02/10/2019

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