Provider Demographics
NPI:1558562314
Name:ELDRIDGE, WENDELL CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:CRAIG
Last Name:ELDRIDGE
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 1:885 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1098
Mailing Address - Country:US
Mailing Address - Phone:419-294-4991
Mailing Address - Fax:419-209-0278
Practice Address - Street 1:420 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-1849
Practice Address - Country:US
Practice Address - Phone:419-626-5623
Practice Address - Fax:419-626-8778
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236248Medicaid
OH2797899Medicaid
OH0236248Medicaid
OH4225524Medicare PIN
OH4225522Medicare PIN
OH9284951Medicare PIN