Provider Demographics
NPI:1194793976
Name:WENDT, ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:WENDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:561-733-4400
Mailing Address - Fax:561-733-5004
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:BLDG A, SUITE 760
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3724
Practice Address - Country:US
Practice Address - Phone:561-733-4400
Practice Address - Fax:561-733-5004
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2014-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-108401208000000X
CAC53816208000000X
FLME117593208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH84905Medicare UPIN