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General NPI Number Information
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NPI Number | 1073019337
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Entity Type | Individual
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Provider Name | PETER BRADLEY WENN MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1000 E PARIS AVE SE STE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8383
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Country | US
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Telephone | 616-685-3450
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776974
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City | CHICAGO
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State | IL
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Zip | 60677-6974
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Country | US
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Telephone | 800-494-5797
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Fax |
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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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 4301514298
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301514298
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License Number State | MI
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