Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 37630 | KY |
N | 207NS0135X | Procedural Dermatology | 37630 | KY |
NPI | 1306934534 |
---|---|
Provider Name | Daniel Wendelin |
First Address | Louisville, KY 40295-0266 |
Second Address | Louisville, KY 40205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 09/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2443573000 | PASSPORT ADVANTAGE (01) | KY |
50002034 | PASSPORT (01) | KY |
64060932-00 | (05) | KY |
H78722 | (02) | KY |