Provider Demographics
NPI:1306945068
Name:WENDROW, MICHAEL S
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:WENDROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 NE 125TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5014
Mailing Address - Country:US
Mailing Address - Phone:305-899-0266
Mailing Address - Fax:305-895-0472
Practice Address - Street 1:1125 NE 125TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5014
Practice Address - Country:US
Practice Address - Phone:305-899-0266
Practice Address - Fax:305-895-0472
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22349OtherBLCBLS OF FLORIDA
FL22349OtherBLCBLS OF FLORIDA
FLT94051Medicare UPIN