Healthcare Provider Details

I. General information

NPI: 1356393003
Provider Name (Legal Business Name): MICHAEL JOHN WENDINGER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MINNESOTA DULUTH 1216 ORDEAN COURT
DULUTH MN
55812-3032
US

IV. Provider business mailing address

1503 MINNEAPOLIS AVE
DULUTH MN
55803-1867
US

V. Phone/Fax

Practice location:
  • Phone: 218-726-8637
  • Fax: 218-726-6529
Mailing address:
  • Phone: 218-728-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1430
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: