Provider Demographics
NPI:1831592690
Name:PETER B WOLLSCHLAEGER MEDICAL PLLC
Entity type:Organization
Organization Name:PETER B WOLLSCHLAEGER MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLLSCHLAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-381-1526
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-0488
Mailing Address - Country:US
Mailing Address - Phone:517-381-1526
Mailing Address - Fax:517-381-1632
Practice Address - Street 1:1380 HASLETT RD
Practice Address - Street 2:SUITE 17
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-7623
Practice Address - Country:US
Practice Address - Phone:517-381-1526
Practice Address - Fax:517-381-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty