MEDICARE: MEGAN WENGER MS, LAT, ATC

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	2083S0010X	Sports Medicine (Preventive Medicine) Physician	092086	IA

General Provider Information

NPI Number	:	1619640885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN WENGER MS, LAT, ATC

Provider Business Mailing Address
First Line	:	2802 SHAMAN AVE SW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-4883
Country	:	US
Telephone Number	:	319-533-3950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 1ST AVE NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-5008
Country	:	US
Telephone Number	:	319-533-3950
Fax Number	:

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

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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