Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | RETIRED | FL |
NPI | 1144342502 |
---|---|
Provider Name | Dr. Michael A. Wohlschlaeger |
First Address | Boaz, AL 35957-0916 |
Second Address | Boaz, AL 35957-4767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U-13036 | (02) |