Provider Demographics
NPI:1841612413
Name:WENDEL, EARL (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:WENDEL
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 1:1045 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1350
Mailing Address - Country:US
Mailing Address - Phone:708-386-5277
Mailing Address - Fax:
Practice Address - Street 1:1045 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1350
Practice Address - Country:US
Practice Address - Phone:708-386-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-040537208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology