Provider Demographics
NPI:1558378323
Name:WENZEL, JOHN D (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:WENZEL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1667 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1809
Mailing Address - Country:US
Mailing Address - Phone:517-349-9551
Mailing Address - Fax:517-349-7650
Practice Address - Street 1:1667 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1809
Practice Address - Country:US
Practice Address - Phone:517-349-9551
Practice Address - Fax:517-349-7650
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853301424OtherBCBS OF MICHIGAN
MIG39561Medicare UPIN