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General NPI Number Information
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NPI Number | 1023677648
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Entity Type | Individual
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Provider Name | WENTAO MI MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 2451 INTELLIPLEX DR STE 250
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City | SHELBYVILLE
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State | IN
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Zip | 46176-8581
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Country | US
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Telephone | 317-398-5267
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Fax | 317-401-2211
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Provider Business Mailing Address
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Address Line | 1010 MAIN ST FL 2
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City | BUFFALO
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State | NY
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Zip | 14202-1102
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Country | US
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Telephone | 716-829-5060
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Fax | 716-829-5051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 01096384A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01096384A
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License Number State | IN
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