Provider Demographics
NPI:1396832242
Name:WENDT, MARK D (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:WENDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:401 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-2409
Mailing Address - Country:US
Mailing Address - Phone:620-431-1938
Mailing Address - Fax:
Practice Address - Street 1:629 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1928
Practice Address - Country:US
Practice Address - Phone:620-431-4000
Practice Address - Fax:620-431-7556
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0526245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2456456301Medicaid
KSG31872Medicare UPIN