Healthcare Provider Details

I. General information

NPI: 1841618972
Provider Name (Legal Business Name): LUKE WENDT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 400 N
OREM UT
84057-1950
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-3424
  • Fax:
Mailing address:
  • Phone:
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number301507
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11897022-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: