Provider Demographics
NPI:1134125263
Name:WENSTRUP, BRAD ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ROBERT
Last Name:WENSTRUP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-618-9011
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:7575 FIVE MILE ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230
Practice Address - Country:US
Practice Address - Phone:513-232-6677
Practice Address - Fax:513-232-2522
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2319 W213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1894669001OtherCIGNA
OH0629967Medicaid
OH0000000318320OtherANTHEM
OH2700623OtherUNITED HEALTHCARE
OHP-11190257OtherMULTIPLAN
T80713Medicare UPIN
OH0629967Medicaid
OH0225920002Medicare NSC