Provider Demographics
NPI:1508836016
Name:WENDT, DAVID MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW
Last Name:WENDT
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 1:19234 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1706
Mailing Address - Country:US
Mailing Address - Phone:440-356-3640
Mailing Address - Fax:440-356-3729
Practice Address - Street 1:19234 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1706
Practice Address - Country:US
Practice Address - Phone:440-356-3640
Practice Address - Fax:440-356-3729
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000232253OtherANTHEM
080189174OtherRAILROAD MEDICARE
OHP00706005OtherRRCARE
OH2338983Medicaid
NDC80324OtherSUMMA
OH000000540966OtherANTHEM /ROCKY RIVER
OHP00613207OtherRAILROAD MEDICARE
080189174OtherRAILROAD MEDICARE
H62522Medicare UPIN
OHWE4084227Medicare ID - Type Unspecified
OH2338983Medicaid