MEDICARE: DR. HANS O WENDENBURG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D6206	TX

General Provider Information

NPI Number	:	1073716486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANS O WENDENBURG M.D.

Provider Business Mailing Address
First Line	:	2990 RICHMOND AVE
Second Line	:	SUITE 142
City	:	HOUSTON
State	:	TX
Zip	:	77098-3104
Country	:	US
Telephone Number	:	713-520-0358
Fax Number	:	713-520-5903

Provider Business Practice Location Address
First Line	:	2990 RICHMOND AVE
Second Line	:	SUITE 142
City	:	HOUSTON
State	:	TX
Zip	:	77098-3104
Country	:	US
Telephone Number	:	713-520-0358
Fax Number	:	713-520-5903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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