Provider Demographics
NPI:1053328153
Name:JOHN D WENZEL DO PLLC
Entity Type:Organization
Organization Name:JOHN D WENZEL DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-349-9550
Mailing Address - Street 1:1667 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1809
Mailing Address - Country:US
Mailing Address - Phone:517-349-9550
Mailing Address - Fax:517-349-7650
Practice Address - Street 1:1667 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1809
Practice Address - Country:US
Practice Address - Phone:517-349-9550
Practice Address - Fax:517-349-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853301424OtherBCBS OF MI
MI0853301424OtherBCBS OF MI