Healthcare Provider Details

I. General information

NPI: 1649244856
Provider Name (Legal Business Name): DAVID T WAHLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W COLUMBIA ST SUITE 310
EVANSVILLE IN
47710-1782
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-425-2646
  • Fax: 812-467-7209
Mailing address:
  • Phone: 812-425-2646
  • Fax: 812-467-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number01041430A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01041430A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: