Organization
K. WENSLEY. MICHAEL MD, PC
Active
Parent organization
MICHAEL KEITH WENSLEY MD INC A MEDICAL CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
MICHAEL KEITH WENSLEY MD INC A MEDICAL CORPORATION
Authorized official
TAMMY KNICKERBOCKER OTHER (MANAGER)
(949) 467-9081
Entity
Organization
Contact information
Practice address
1601 DOVE ST STE 170, NEWPORT BEACH, CA 92660-1421
(949) 674-9081
(209) 203-1036
Mailing address
1601 DOVE ST STE 170, NEWPORT BEACH, CA 92660-1421
(949) 674-9081
(209) 203-1036
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/29/2024
Last updated
08/12/2024
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