Provider Demographics
NPI:1497012710
Name:WENDROTH, SCOTT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:WENDROTH
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 1:750 W HIGH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2967
Mailing Address - Country:US
Mailing Address - Phone:419-226-9224
Mailing Address - Fax:419-996-5298
Practice Address - Street 1:750 W HIGH ST STE 400
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2967
Practice Address - Country:US
Practice Address - Phone:419-226-9224
Practice Address - Fax:419-996-5298
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.130291207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program