MEDICARE: ANDREW HOWARD WENGER DO

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	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	008455	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program		NM
3	207P00000X	Emergency Medicine Physician	5101024531	MI

General Provider Information

NPI Number	:	1336677566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW HOWARD WENGER DO

Provider Business Mailing Address
First Line	:	5301 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2805
Country	:	US
Telephone Number	:	520-324-2308
Fax Number	:	520-324-1406

Provider Business Practice Location Address
First Line	:	5301 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2805
Country	:	US
Telephone Number	:	520-324-3771
Fax Number	:	520-324-1082

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

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	03/12/2026

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