Healthcare Provider Details

I. General information

NPI: 1710982145
Provider Name (Legal Business Name): ROGER LEE WOHLWEND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 N HOLLAND SYLVANIA RD STE B
TOLEDO OH
43623-2503
US

IV. Provider business mailing address

4139 N HOLLAND SYLVANIA RD STE B
TOLEDO OH
43623-2503
US

V. Phone/Fax

Practice location:
  • Phone: 419-885-7212
  • Fax: 419-885-7204
Mailing address:
  • Phone: 419-885-7212
  • Fax: 419-885-7204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34004668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: