MEDICARE: DR. MARC WAHLQUIST 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	35084068	OH

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	:	1417039801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC WAHLQUIST M.D.

Provider Business Mailing Address
First Line	:	6480 HARRISON AVE STE 201
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7961
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-699-1435

Provider Business Practice Location Address
First Line	:	7794 5 MILE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2368
Country	:	US
Telephone Number	:	513-354-3700
Fax Number	:	513-977-9643

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	04/14/2025

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