Individual
DANIEL WENDELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2811 KLEMPNER WAY, LOUISVILLE, KY 40205
(502) 896-6355
(502) 896-9813
Mailing address
PO BOX 950266, LOUISVILLE, KY 40295-0266
(502) 896-6355
(502) 896-9813
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
37630
KY
207NS0135X
Procedural Dermatology Physician
37630
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2443573000
PASSPORT ADVANTAGE
KY
01
—
50002034
PASSPORT
KY
05
—
64060932-00
—
KY
Enumeration date
10/11/2006
Last updated
06/09/2020
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