Provider Demographics
NPI:1285793844
Name:VENTLING, WAYNE LEROY II (DO)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:LEROY
Last Name:VENTLING
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 KIMBALL AVENUE
Mailing Address - Street 2:CO CINDY SNELL CEDAR VALLEY MEDICAL SPECIALISTS
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701
Mailing Address - Country:US
Mailing Address - Phone:219-235-5390
Mailing Address - Fax:319-233-1630
Practice Address - Street 1:4150 KIMBALL AVENUE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:219-235-5390
Practice Address - Fax:319-233-1630
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA027472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E30971Medicare UPIN