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NPI Code Detail

MEDICARE: DR. LOUISE JOHNSON WUNSCH LOUISE WUNSCH, MD

MEDICARE: DR. LOUISE JOHNSON WUNSCH LOUISE WUNSCH, MD
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
1208D00000XGeneral Practice PhysicianME 104743FL

General Provider Information

NPI Number : 1225365158
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOUISE JOHNSON WUNSCH LOUISE WUNSCH, MD
Provider Business Mailing Address
First Line : 6800 N DALE MABRY HWY STE 270
Second Line :
City : TAMPA
State : FL
Zip : 33614-3999
Country : US
Telephone Number : 800-223-1172
Fax Number :
Provider Business Practice Location Address
First Line : 6800 N DALE MABRY HWY STE 270
Second Line :
City : TAMPA
State : FL
Zip : 33614-3999
Country : US
Telephone Number : 800-223-1172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2009
Last Update Date : 11/13/2009

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