MEDICARE: ELIJAH SHEA WENDT

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1083423214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIJAH SHEA WENDT

Provider Business Mailing Address
First Line	:	2861 RADIUS CIR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6869
Country	:	US
Telephone Number	:	208-596-6269
Fax Number	:

Provider Business Practice Location Address
First Line	:	178 S 32ND ST W STE 3
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6889
Country	:	US
Telephone Number	:	406-702-1323
Fax Number	:

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

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	02/24/2025

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Directions to “ ELIJAH SHEA WENDT ” Practice Location

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