Healthcare Provider Details

I. General information

NPI: 1114216652
Provider Name (Legal Business Name): BERND WOLLSCHLAEGER,MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16899 NE 15TH AVE
NORTH MIAMI BEACH FL
33162-2914
US

IV. Provider business mailing address

16899 NE 15TH AVE
NORTH MIAMI BEACH FL
33162-2914
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-8717
  • Fax:
Mailing address:
  • Phone: 305-940-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME72143
License Number StateFL

VIII. Authorized Official

Name: DR. BERND ARTHUR WOLLSCHLAEGER
Title or Position: CEO & PRESIDENT
Credential: MD
Phone: 305-940-8717