MEDICARE: DR. CHRISTIAN JON WUNDERLICH D.P.M.

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	213E00000X	Podiatrist	000476	MO

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	:	1528015070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN JON WUNDERLICH D.P.M.

Provider Business Mailing Address
First Line	:	118 E JEFFERSON AVE
Second Line	:	SUITE 200
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-4026
Country	:	US
Telephone Number	:	314-821-6585
Fax Number	:	314-821-6594

Provider Business Practice Location Address
First Line	:	118 E JEFFERSON AVE
Second Line	:	SUITE 200
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-4026
Country	:	US
Telephone Number	:	314-821-6585
Fax Number	:	314-821-6594

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	07/13/2010

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