Provider Demographics
NPI:1942590435
Name:WENDT, JAMES BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:WENDT
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 1:4208 E OLD PINE TRL
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8892
Mailing Address - Country:US
Mailing Address - Phone:989-631-3143
Mailing Address - Fax:
Practice Address - Street 1:4208 E OLD PINE TRL
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8892
Practice Address - Country:US
Practice Address - Phone:989-631-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035802207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology