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NPI Code Detail

MEDICARE: WENSLEY M KEITH MD, PC

MEDICARE: WENSLEY M KEITH MD, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1790530004
Entity Type Code : Organization
Provider Name (Legal Business Name) : WENSLEY M KEITH MD, PC
Provider Business Mailing Address
First Line : 1601 DOVE ST STE 170
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-1421
Country : US
Telephone Number : 949-705-8226
Fax Number : 209-203-1036
Provider Business Practice Location Address
First Line : 1601 DOVE ST STE 170
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-1421
Country : US
Telephone Number : 949-467-9081
Fax Number : 209-203-1036
Authorized Official
Title or Position : CEO
Name : MICHAEL KEITH WENSLEY
Credential : MD
Telephone Number : 949-467-9081
Provider Enumeration Date : 04/19/2024
Last Update Date : 03/28/2025

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Directions to “WENSLEY M KEITH MD, PC ” Practice Location

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