Provider Demographics
NPI:1700804911
Name:TENNEY, WM. DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:WM.
Middle Name:DAVID
Last Name:TENNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6211
Mailing Address - Country:US
Mailing Address - Phone:440-974-3338
Mailing Address - Fax:
Practice Address - Street 1:8899 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6211
Practice Address - Country:US
Practice Address - Phone:440-974-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001599213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000042987OtherANTHEM BCBS
OH00000042988OtherANTHEM BCBS
OH0232948Medicaid
OH480012319OtherRAILROAD MEDICARE
OH34671135300OtherBUR WORK COMP
OH34671135301OtherBUR WORK COMP
OH480031264BOtherRAILROAD MEDICARE
OH0232948Medicaid
OH34671135300OtherBUR WORK COMP
OHU26023Medicare UPIN