Healthcare Provider Details

I. General information

NPI: 1841257334
Provider Name (Legal Business Name): MICHAEL CARL WOHLFAHRT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 SE 165TH MULBERRY LN
THE VILLAGES FL
32162-5884
US

IV. Provider business mailing address

127 HEATHER OAKS CIR
LADY LAKE FL
32159-4399
US

V. Phone/Fax

Practice location:
  • Phone: 352-674-5000
  • Fax: 352-674-5001
Mailing address:
  • Phone: 352-674-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004855
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: