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NPI Code Detail

MEDICARE: VAN E WAHLGREN MD

MEDICARE:   VAN E WAHLGREN  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
1207X00000XOrthopaedic Surgery Physician48759WI

General Provider Information

NPI Number : 1720077605
Entity Type Code : Individual
Provider Name (Legal Business Name) : VAN E WAHLGREN MD
Provider Business Mailing Address
First Line : 2321 STOUT RD
Second Line :
City : MENOMONIE
State : WI
Zip : 54751-7003
Country : US
Telephone Number : 715-235-5531
Fax Number : 715-233-7645
Provider Business Practice Location Address
First Line : 2321 STOUT RD
Second Line :
City : MENOMONIE
State : WI
Zip : 54751-7003
Country : US
Telephone Number : 715-235-5531
Fax Number : 715-233-7645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 09/05/2007

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Directions to “ VAN E WAHLGREN MD” Practice Location

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