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General NPI Number Information
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NPI Number | 1013971175
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Entity Type | Individual
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Provider Name | THERESA MARIE WAHLIG M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 6TH AVE
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City | DES MOINES
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State | IA
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Zip | 50314-2613
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Country | US
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Telephone | 515-643-8409
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Fax |
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Provider Business Mailing Address
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Address Line | 300 WALNUT ST #59
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City | DES MOINES
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State | IA
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Zip | 50309-2224
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Country | US
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Telephone | 515-643-8409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 28238
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License Number State | IA
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