| Doctor Name: | MICHAEL RYAN WUELLNER |
| NPI Number: | 1922395334 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | H.A.S. |
| License Number: | AS4088 |
| Business Practice Address: | 3600 E State St Suite 324 Rockford, IL - 611081978 |
| Business Phone Number: | 8152279380 |
| Business Fax Number: | 8152279387 |
| Mailing Address: | 6 Victory Drive, LIBERTY |
| State: | MO |
| Postal Code: | 64068 |
| Phone Number: | 8168832660 |
| Fax Number: | 8167929819 |
| NPI Enumeration Date: | 07/06/2011 |
| NPI Last Update Date: | 03/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | AS4088 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |