MEDICARE: MICHAEL EUGENE WETTSTEIN 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	A67921	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00415474	OTHER	WA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1245271303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL EUGENE WETTSTEIN MD

Provider Business Mailing Address
First Line	:	11406 LOMA LINDA DR STE 516
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3711
Country	:	US
Telephone Number	:	909-558-6204
Fax Number	:

Provider Business Practice Location Address
First Line	:	11406 LOMA LINDA DR STE 516
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3711
Country	:	US
Telephone Number	:	909-558-6204
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	05/14/2021

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