Individual
DR. ELLIOTT LYLE WENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2929 SUMMIT ST, 101, OAKLAND, CA 94609-3423
(510) 832-3137
(510) 338-0760
Mailing address
6425 OAKWOOD DR, OAKLAND, CA 94611-1350
(510) 832-3137
(510) 338-0760
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E1759
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E17590
—
CA
05
—
000E17591
—
CA
Enumeration date
06/19/2006
Last updated
01/05/2017
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