Provider Demographics
NPI:1891756383
Name:WENDORFF, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:WENDORFF
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 1:3055 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2751
Mailing Address - Country:US
Mailing Address - Phone:614-875-9900
Mailing Address - Fax:614-875-4033
Practice Address - Street 1:3055 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2751
Practice Address - Country:US
Practice Address - Phone:614-875-9900
Practice Address - Fax:614-875-4033
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH052244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0664517Medicaid
A16852Medicare UPIN
OHWE0597301Medicare ID - Type Unspecified