Provider Demographics
NPI:1457496564
Name:RONALD J WAHLIG, MD, INC
Entity Type:Organization
Organization Name:RONALD J WAHLIG, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WAHLIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-559-8276
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-0650
Mailing Address - Country:US
Mailing Address - Phone:310-559-8276
Mailing Address - Fax:310-559-8284
Practice Address - Street 1:2476 OVERLAND AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3370
Practice Address - Country:US
Practice Address - Phone:310-559-8276
Practice Address - Fax:310-559-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76939207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76939Medicare ID - Type Unspecified