Provider Demographics
NPI:1689744583
Name:WOLLSCHLAEGER, BERND ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:BERND
Middle Name:ARTHUR
Last Name:WOLLSCHLAEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16899 NE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2914
Mailing Address - Country:US
Mailing Address - Phone:305-940-8717
Mailing Address - Fax:305-402-2989
Practice Address - Street 1:16899 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2914
Practice Address - Country:US
Practice Address - Phone:305-940-8717
Practice Address - Fax:305-402-2989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72143207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63774Medicare UPIN