Provider Demographics
NPI:1245364504
Name:WOLLSCHLAEGER, PETER BERNARD (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:BERNARD
Last Name:WOLLSCHLAEGER
Suffix:
Gender:
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N WATER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5673
Mailing Address - Country:US
Mailing Address - Phone:517-974-6227
Mailing Address - Fax:
Practice Address - Street 1:1111 N WATER ST STE 201
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5673
Practice Address - Country:US
Practice Address - Phone:517-974-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P31090OtherGROUP # MEDICARE
MI0N77190OtherGROUP MEDICARE ID
MI0N77190004OtherMEDICARE PIN
Y54242Medicare UPIN
0P31090OtherGROUP # MEDICARE