Healthcare Provider Details

I. General information

NPI: 1063497204
Provider Name (Legal Business Name): ANDREW ROBERT WENTZEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S LINCOLN RD
ESCANABA MI
49829-1215
US

IV. Provider business mailing address

610 S LINCOLN RD
ESCANABA MI
49829-1215
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-6488
  • Fax: 906-786-6409
Mailing address:
  • Phone: 906-786-6488
  • Fax: 906-786-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44241
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: