Provider Demographics
NPI:1518072883
Name:STEUDEL, WOLFGANG (MD)
Entity Type:Individual
Prefix:
First Name:WOLFGANG
Middle Name:
Last Name:STEUDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-5969
Mailing Address - Country:US
Mailing Address - Phone:617-785-5448
Mailing Address - Fax:877-629-8029
Practice Address - Street 1:541 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5969
Practice Address - Country:US
Practice Address - Phone:617-785-5448
Practice Address - Fax:877-629-8029
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205828207L00000X
NY255826-1207L00000X
CO40418207L00000X
MT50980207L00000X
TN64026207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0160580Medicaid
CO78709342Medicaid
H52958Medicare UPIN
MAA33419Medicare ID - Type Unspecified
473258Medicare ID - Type Unspecified