Provider Demographics
NPI:1568458065
Name:SCHEELE, WOLFGANG (MD)
Entity Type:Individual
Prefix:
First Name:WOLFGANG
Middle Name:
Last Name:SCHEELE
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 1:201 S ALVARADO ST
Mailing Address - Street 2:SUITE 609
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2320
Mailing Address - Country:US
Mailing Address - Phone:213-413-5040
Mailing Address - Fax:213-413-2985
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 609
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-413-5040
Practice Address - Fax:213-413-2985
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2012-12-14
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
CAA030496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA30496EMedicare PIN
CAA30496Medicare PIN