Provider Demographics
NPI:1164706073
Name:WENDT, MICHAEL THOMAS (PAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:WENDT
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:10000 TELEGRAPH ROAD
Mailing Address - Street 2:PROFESSIONAL EMERGENCY CARE, PC
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3330
Mailing Address - Country:US
Mailing Address - Phone:313-295-5007
Mailing Address - Fax:313-295-6725
Practice Address - Street 1:38935 ANN ARBOR ROAD
Practice Address - Street 2:PROFESSIONAL EMERGENCY CARE, PC
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3397
Practice Address - Country:US
Practice Address - Phone:734-632-0175
Practice Address - Fax:866-250-6385
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
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Provider Licenses
StateLicense IDTaxonomies
MI5601006220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601006220OtherSTATE LICENSE
MIPENDINGOtherCAQH