Healthcare Provider Details

I. General information

NPI: 1386690766
Provider Name (Legal Business Name): WLADIMIR WERTELECKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 UNIVERSITY BLVD N CC/CB 214
MOBILE AL
36688-3053
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-7500
  • Fax: 251-460-3837
Mailing address:
  • Phone: 251-470-5842
  • Fax: 251-470-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number6855
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: