Healthcare Provider Details

I. General information

NPI: 1336192061
Provider Name (Legal Business Name): DANIEL F WENDELBORN MD
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

436 B EAST LONGVIEW DRIVE
APPLETON WI
54911
US

IV. Provider business mailing address

436 B EAST LONGVIEW DRIVE
APPLETON WI
54911
US

V. Phone/Fax

Practice location:
  • Phone: 920-739-5213
  • Fax:
Mailing address:
  • Phone: 920-739-5213
  • Fax: 920-739-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number28455
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: