Healthcare Provider Details

I. General information

NPI: 1356780662
Provider Name (Legal Business Name): DANIEL JACOB WURZELMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MARTIN LUTHER KING JR BLVD
CHAPEL HILL NC
27514-2600
US

IV. Provider business mailing address

6112 SAINT GILES ST
RALEIGH NC
27612-7043
US

V. Phone/Fax

Practice location:
  • Phone: 919-893-4465
  • Fax:
Mailing address:
  • Phone: 919-893-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301102662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: