MEDICARE: BRENT R. WENDEL, DPM, INC, P.S.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO00000621	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101063	OTHER	WA	LABOR & INDUSTRY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942394853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENT R. WENDEL, DPM, INC, P.S.

Provider Business Mailing Address
First Line	:	600 BROADWAY
Second Line	:	SUITE 220
City	:	SEATTLE
State	:	WA
Zip	:	98122-5373
Country	:	US
Telephone Number	:	206-860-4300
Fax Number	:	206-860-0907

Provider Business Practice Location Address
First Line	:	600 BROADWAY
Second Line	:	SUITE 220
City	:	SEATTLE
State	:	WA
Zip	:	98122-5373
Country	:	US
Telephone Number	:	206-860-4300
Fax Number	:	206-860-0907

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRENT ROBERT WENDEL
Credential	:	DPM
Telephone Number	:	206-860-4300

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/19/2008

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