Healthcare Provider Details

I. General information

NPI: 1649240995
Provider Name (Legal Business Name): MICHAEL O. WENDT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 SUMMERPLACE DR
WEST COLUMBIA SC
29169-3058
US

IV. Provider business mailing address

PO BOX 2564
COLUMBIA SC
29202-2564
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-1838
  • Fax: 803-765-1732
Mailing address:
  • Phone: 803-765-1838
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL O. WENDT
Title or Position: MANAGER/MANAGING MEMBER
Credential: MD
Phone: 803-454-2600