Healthcare Provider Details

I. General information

NPI: 1194793976
Provider Name (Legal Business Name): ALLEN WENDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HAGEN RANCH RD BLDG A, SUITE 760
BOYNTON BEACH FL
33437-3724
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-4400
  • Fax: 561-733-5004
Mailing address:
  • Phone: 561-733-4400
  • Fax: 561-733-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-108401
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC53816
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME117593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: