MEDICARE: DR. MICHAEL P WANGER 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	207R00000X	Internal Medicine Physician	ME0072212	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110159498	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1437101359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P WANGER MD

Provider Business Mailing Address
First Line	:	1007 JEFFORDS ST STE 101
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4082
Country	:	US
Telephone Number	:	727-461-7908
Fax Number	:	727-223-5269

Provider Business Practice Location Address
First Line	:	516 LAKEVIEW RD
Second Line	:	BLDG 4
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3302
Country	:	US
Telephone Number	:	727-461-7908
Fax Number	:	727-223-5269

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/14/2022

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