Individual
WADE WENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6913 N MAIN ST, GRANGER, IN 46530
(574) 647-1550
Mailing address
21717 KNOBCONE CT, BRISTOL, IN 46507-9690
(574) 850-1123
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101029795
VA
207P00000X
Emergency Medicine Physician
01064515A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200886980
—
IN
Enumeration date
06/09/2006
Last updated
11/01/2012
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