MEDICARE: JOHN K WOLLAEGER 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
1	207X00000X	Orthopaedic Surgery Physician	38147	WI

General Provider Information

NPI Number	:	1740278860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN K WOLLAEGER MD

Provider Business Mailing Address
First Line	:	1624 S HIGH POINT RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-4401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 S HIGH POINT RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-4401
Country	:	US
Telephone Number	:	608-287-2700
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	01/31/2023

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