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General NPI Number Information
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NPI Number | 1164538864
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Entity Type | Individual
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Provider Name | ROBERT WOCHNER MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 1005 HEALTH CENTER DRIVE SUITE 103
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City | MATTOON
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State | IL
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Zip | 61938
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Country | US
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Telephone | 217-258-4051
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Fax | 217-258-4063
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Provider Business Mailing Address
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Address Line | 1005 HEALTH CENTER DRIVE SUITE 103
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City | MATTOON
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State | IL
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Zip | 61938
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Country | US
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Telephone | 217-258-4051
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Fax | 217-258-4063
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-082126
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License Number State | IL
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