Provider Demographics
NPI:1639169519
Name:MEHLING, WOLF-EBERHARD (MD)
Entity Type:Individual
Prefix:
First Name:WOLF-EBERHARD
Middle Name:
Last Name:MEHLING
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 1:2395 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2601
Mailing Address - Country:US
Mailing Address - Phone:415-796-2242
Mailing Address - Fax:
Practice Address - Street 1:2395 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2601
Practice Address - Country:US
Practice Address - Phone:415-796-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75790207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A757900Medicaid
CA00A757900OtherBLUE SHIELD
CA00A757901Medicare ID - Type Unspecified
CA00A757900Medicaid