Provider Demographics
NPI:1619069549
Name:LAMBERT, WENDY W (DO)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:W
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13450 E 12 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3671
Mailing Address - Country:US
Mailing Address - Phone:586-759-5525
Mailing Address - Fax:586-759-4765
Practice Address - Street 1:13450 E 12 MILE ROAD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3671
Practice Address - Country:US
Practice Address - Phone:586-759-5525
Practice Address - Fax:586-759-4765
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWL007476207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5500132Medicare ID - Type Unspecified
MIE26891Medicare UPIN