Provider Demographics
NPI:1942394853
Name:BRENT R. WENDEL, DPM, INC, P.S.
Entity Type:Organization
Organization Name:BRENT R. WENDEL, DPM, INC, P.S.
Other - Org Name:PUGET SOUND FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-860-4300
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5373
Mailing Address - Country:US
Mailing Address - Phone:206-860-4300
Mailing Address - Fax:206-860-0907
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5373
Practice Address - Country:US
Practice Address - Phone:206-860-4300
Practice Address - Fax:206-860-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000621213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101063OtherLABOR & INDUSTRY
WA1106616Medicaid
WA0364070001Medicare NSC
WAAB14115Medicare PIN
WA101063OtherLABOR & INDUSTRY