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General NPI Number Information
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NPI Number | 1831592690
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Entity Type | Organization
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Legal Business Name | PETER B WOLLSCHLAEGER MEDICAL PLLC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 1380 HASLETT RD SUITE 17
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City | HASLETT
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State | MI
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Zip | 48840-7623
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Country | US
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Telephone | 517-381-1526
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Fax | 517-381-1632
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Provider Business Mailing Address
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Address Line | PO BOX 488
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City | HASLETT
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State | MI
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Zip | 48840-0488
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Country | US
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Telephone | 517-381-1526
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Fax | 517-381-1632
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Authorized Official
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Title or Position | OWNER
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Name | PETER B WOLLSCHLAEGER
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Credential | MD
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Telephone | 517-381-1526
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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 | 4301068371
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License Number State | MI
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