Provider Demographics
NPI:1730101072
Name:WINCKELBACH, WENDY SUE (DPM)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SUE
Last Name:WINCKELBACH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E COUNTY LINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1043
Mailing Address - Country:US
Mailing Address - Phone:317-882-9303
Mailing Address - Fax:317-882-6605
Practice Address - Street 1:33 E COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1043
Practice Address - Country:US
Practice Address - Phone:317-882-9303
Practice Address - Fax:317-882-6605
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000959B213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200857990Medicaid
INU95019Medicare UPIN
IN4691620001Medicare NSC