Healthcare Provider Details

I. General information

NPI: 1497738314
Provider Name (Legal Business Name): JULIE A WENDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21803 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85255-7438
US

IV. Provider business mailing address

PO BOX 28634
SCOTTSDALE AZ
85255-0160
US

V. Phone/Fax

Practice location:
  • Phone: 480-500-1902
  • Fax: 480-500-1909
Mailing address:
  • Phone: 480-500-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number44006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: