Provider Demographics
NPI:1699723767
Name:WENDLING, LYLE R (MD)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:R
Last Name:WENDLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 W 5TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2823
Mailing Address - Country:US
Mailing Address - Phone:509-747-1187
Mailing Address - Fax:509-747-1180
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2823
Practice Address - Country:US
Practice Address - Phone:509-747-1187
Practice Address - Fax:509-747-1180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000143842085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8242604Medicaid
WA0160231OtherWA LABOR & INDUSTRIES
WA8242604Medicaid
WAE98281Medicare UPIN