Individual
AMANDA B. WENDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2900 FOXFIELD RD STE 101, ST CHARLES, IL 60174-5799
(630) 315-6500
(630) 315-6519
Mailing address
5N134 PRAIRIE ROSE DR, ST CHARLES, IL 60175-7943
(217) 816-9254
(319) 339-3874
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036127582
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
906720
MEDICARE PTAN
IL
Enumeration date
07/05/2007
Last updated
07/18/2019
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