NPI Code Detail JSON Logo

1689194243 NPI number — BENJAMIN MARK WAHLE MD

NPI Number: 1689194243
Health Care Provider/Practitioner: BENJAMIN MARK WAHLE MD

Information about “1689194243” NPI (BENJAMIN MARK WAHLE MD) exists in 1689194243 in HTML format HTML  |  1689194243 in plain Text format TXT  |  1689194243 in PDF (Portable Document Format) PDF  |  1689194243 in an XML format XML  formats.

NPI Number : 1689194243 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689194243",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WAHLE",
    "FirstName": "BENJAMIN",
    "MiddleName": "MARK",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 7412011",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60674-2011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-362-7509",
    "MailingAddressFaxNumber": "888-452-4025",
    "FirstLinePracticeLocationAddress": "4500 FOREST PARK AVE",
    "SecondLinePracticeLocationAddress": "DEPT OTOLARYNGOLOGY, 5TH FL",
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63108-2114",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-362-7509",
    "PracticeLocationAddressFaxNumber": "888-452-4025",
    "EnumerationDate": "06/26/2017",
    "LastUpdateDate": "08/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Y00000X",
        "TaxonomyName": "Otolaryngology Physician",
        "LicenseNumber": "2025019752",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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