Provider Demographics
NPI:1306815550
Name:WENDLING, DAVID JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:WENDLING
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 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-423-7028
Mailing Address - Fax:269-423-8282
Practice Address - Street 1:319 W DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-1106
Practice Address - Country:US
Practice Address - Phone:269-423-7028
Practice Address - Fax:269-423-8282
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H060020OtherBCBSM
MI1306815550Medicaid
MI104994980Medicaid
B45333Medicare UPIN
MI1306815550Medicaid