Healthcare Provider Details

I. General information

NPI: 1558378927
Provider Name (Legal Business Name): DR. JOHN C WUELLNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4863 N NEVADA AVE
COLORADO SPRINGS CO
80918-3951
US

IV. Provider business mailing address

3205 N ACADEMY BLVD
COLORADO SPRINGS CO
80917-5147
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036061448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: