Provider Demographics
NPI:1265709315
Name:WENZEL, MARC (MD)
Entity type:Individual
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First Name:MARC
Middle Name:
Last Name:WENZEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 RIO GRANDE ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1137
Mailing Address - Country:US
Mailing Address - Phone:512-324-8960
Mailing Address - Fax:512-324-8962
Practice Address - Street 1:5103 KYLE CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6163
Practice Address - Country:US
Practice Address - Phone:512-551-0855
Practice Address - Fax:512-551-0856
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2012-10-30
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Provider Licenses
StateLicense IDTaxonomies
TXJ1426207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114934604Medicaid
TXTXB143259Medicare PIN