MEDICARE: DR. JOHN HUGH WOLLNER 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	174400000X	Specialist	25852	IA
2	207N00000X	Dermatology Physician	MD-25852	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24580	OTHER	IA	WELLMARK BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568423192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN HUGH WOLLNER M.D.

Provider Business Mailing Address
First Line	:	716 5TH AVE SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-1916
Country	:	US
Telephone Number	:	319-363-9936
Fax Number	:	319-363-0520

Provider Business Practice Location Address
First Line	:	5264 COUNCIL ST NE STE 700
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-2477
Country	:	US
Telephone Number	:	319-363-9936
Fax Number	:	319-363-0520

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/28/2022

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