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General NPI Number Information
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NPI Number | 1528044393
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Entity Type | Individual
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Provider Name | MICHAEL J. VENDRELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 4411 THE 25 WAY NE #150
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-5857
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Country | US
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Telephone | 651-245-3950
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Fax | 413-643-4773
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Provider Business Mailing Address
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Address Line | 4220 HERSCHEL AVE APT 809
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City | DALLAS
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State | TX
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Zip | 75219-2380
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Country | US
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Telephone | 651-245-3950
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 44127
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00047308
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 80-278
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License Number State | NM
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