Provider Demographics
NPI:1225365158
Name:WUNSCH, LOUISE JOHNSON (LOUISE WUNSCH, MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:JOHNSON
Last Name:WUNSCH
Suffix:
Gender:F
Credentials:LOUISE WUNSCH, MD
Other - Prefix:DR
Other - First Name:LOUISE
Other - Middle Name:MINA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOUISE J WUNSCH, MD
Mailing Address - Street 1:6800 N DALE MABRY HWY STE 270
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3999
Mailing Address - Country:US
Mailing Address - Phone:800-223-1172
Mailing Address - Fax:
Practice Address - Street 1:6800 N DALE MABRY HWY STE 270
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3999
Practice Address - Country:US
Practice Address - Phone:800-223-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104743208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice