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General NPI Number Information
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NPI Number | 1154484533
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Entity Type | Organization
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Legal Business Name | KAREN WUNDERLICH MD PA
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 14540 CORTEZ BLVD SUITE 102
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6056
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Country | US
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Telephone | 352-596-7255
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Fax |
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Provider Business Mailing Address
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Address Line | 14540 CORTEZ BLVD SUITE 102
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6056
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Country | US
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Telephone | 352-596-7255
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN WUNDERLICH
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Credential | M.D.
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Telephone | 352-596-7255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME61722
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License Number State | FL
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