Provider Demographics
NPI:1699973131
Name:WENDEL, AMANDA B (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:WENDEL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5N134 PRAIRIE ROSE DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7943
Mailing Address - Country:US
Mailing Address - Phone:217-816-9254
Mailing Address - Fax:319-339-3874
Practice Address - Street 1:2900 FOXFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-315-6500
Practice Address - Fax:630-315-6519
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2019-07-18
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Provider Licenses
StateLicense IDTaxonomies
IL036127582207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL906720OtherMEDICARE PTAN