Provider Demographics
NPI:1194943274
Name:WILDENTHAL, CLAUD KERN (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUD
Middle Name:KERN
Last Name:WILDENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9002
Mailing Address - Country:US
Mailing Address - Phone:214-648-2508
Mailing Address - Fax:214-648-8690
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9002
Practice Address - Country:US
Practice Address - Phone:214-648-2508
Practice Address - Fax:214-648-8690
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1858207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE88560Medicare UPIN