Healthcare Provider Details

I. General information

NPI: 1154882389
Provider Name (Legal Business Name): LAUREN WICHELMANN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MUTH DO

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PLEASANT VALLEY RD
WEST BEND WI
53095-9274
US

IV. Provider business mailing address

3200 PLEASANT VALLEY RD
WEST BEND WI
53095-9274
US

V. Phone/Fax

Practice location:
  • Phone: 262-836-7300
  • Fax:
Mailing address:
  • Phone: 262-836-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101027582
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: