MEDICARE: KAREN M WEGNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	37078	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063419760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN M WEGNER M.D.

Provider Business Mailing Address
First Line	:	3040 N 117TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-4107
Country	:	US
Telephone Number	:	414-479-9990
Fax Number	:	414-479-0230

Provider Business Practice Location Address
First Line	:	3040 N 117TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-4107
Country	:	US
Telephone Number	:	414-479-9990
Fax Number	:	414-479-0230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/19/2007

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Directions to “ KAREN M WEGNER M.D.” Practice Location

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