Provider Demographics
NPI:1841234663
Name:BURESH, WENDY S (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:BURESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 1ST AVE SE STE A1
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5328
Mailing Address - Country:US
Mailing Address - Phone:319-364-1055
Mailing Address - Fax:319-362-1455
Practice Address - Street 1:1953 1ST AVE SE STE A1
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5328
Practice Address - Country:US
Practice Address - Phone:319-364-1055
Practice Address - Fax:319-362-1455
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151886Medicaid
IA0151886Medicaid
E46213Medicare UPIN