Provider Demographics
NPI:1902857071
Name:WENDLAND, DOUGLAS M (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:WENDLAND
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2742
Mailing Address - Country:US
Mailing Address - Phone:218-249-6822
Mailing Address - Fax:218-249-6828
Practice Address - Street 1:4702 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2742
Practice Address - Country:US
Practice Address - Phone:218-249-6822
Practice Address - Fax:218-249-6828
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN465042083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN707657600Medicaid
MN707657600Medicaid
MN080013047Medicare ID - Type Unspecified