Provider Demographics
NPI:1275573354
Name:WENZKE, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:WENZKE
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 1:2925 VERNON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2425
Mailing Address - Country:US
Mailing Address - Phone:513-751-6667
Mailing Address - Fax:513-872-4553
Practice Address - Street 1:2990 MACK RD STE 107
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5384
Practice Address - Country:US
Practice Address - Phone:513-860-4801
Practice Address - Fax:513-682-4186
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084979207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2530890Medicaid
4239941Medicare PIN
OH2530890Medicaid