Healthcare Provider Details

I. General information

NPI: 1942394853
Provider Name (Legal Business Name): BRENT R. WENDEL, DPM, INC, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY SUITE 220
SEATTLE WA
98122-5373
US

IV. Provider business mailing address

600 BROADWAY SUITE 220
SEATTLE WA
98122-5373
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-4300
  • Fax: 206-860-0907
Mailing address:
  • Phone: 206-860-4300
  • Fax: 206-860-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000621
License Number StateWA

VIII. Authorized Official

Name: DR. BRENT ROBERT WENDEL
Title or Position: PRESIDENT
Credential: DPM
Phone: 206-860-4300