Healthcare Provider Details

I. General information

NPI: 1265843726
Provider Name (Legal Business Name): CHARLES ANTHONY WENZEL DO, JD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2014
Last Update Date: 03/15/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549TH HOSPITAL CENTER/BDAACH UNIT #15245
APO AP
96271
US

IV. Provider business mailing address

PSC 444 BOX 1031
APO AP
96297-0011
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1734
  • Fax:
Mailing address:
  • Phone: 303-885-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberDO-05462
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number55576
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: