Provider Demographics
NPI:1174550206
Name:WENDT, CRAIG D (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:D
Last Name:WENDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14695 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1929
Mailing Address - Country:US
Mailing Address - Phone:231-547-2812
Mailing Address - Fax:231-547-3067
Practice Address - Street 1:100 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-7072
Practice Address - Country:US
Practice Address - Phone:715-524-2161
Practice Address - Fax:715-524-8164
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050053208600000X
WI70871208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3293873Medicaid
MI3293873Medicaid
MIB47543Medicare UPIN