Provider Demographics
NPI:1114216652
Name:BERND WOLLSCHLAEGER,MD PA
Entity type:Organization
Organization Name:BERND WOLLSCHLAEGER,MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERND
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:WOLLSCHLAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-940-8717
Mailing Address - Street 1:16899 NE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2914
Mailing Address - Country:US
Mailing Address - Phone:305-940-8717
Mailing Address - Fax:
Practice Address - Street 1:16899 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2914
Practice Address - Country:US
Practice Address - Phone:305-940-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72143261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service