MEDICARE: DR. NORMAN WETTERAU MD

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	207Q00000X	Family Medicine Physician	105928	NY
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	105928	NY

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	:	1063460061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN WETTERAU MD

Provider Business Mailing Address
First Line	:	PO BOX 601
Second Line	:	10869 RTE 36 SOUTH
City	:	DANSVILLE
State	:	NY
Zip	:	14437-0601
Country	:	US
Telephone Number	:	585-335-3416
Fax Number	:	585-335-8695

Provider Business Practice Location Address
First Line	:	61 STATE ST
Second Line	:
City	:	NUNDA
State	:	NY
Zip	:	14517-9785
Country	:	US
Telephone Number	:	585-468-2528
Fax Number	:	585-468-5424

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/31/2012

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