Provider Demographics
NPI:1992750830
Name:WEGEHAUPT, PAUL K (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:WEGEHAUPT
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 1:2251 N SHORE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8360
Mailing Address - Country:US
Mailing Address - Phone:715-361-4700
Mailing Address - Fax:
Practice Address - Street 1:2251 NORTH SHORE DR
Practice Address - Street 2:STE 200
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8360
Practice Address - Country:US
Practice Address - Phone:715-361-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31472800Medicaid
D87507Medicare UPIN