Individual
THOMAS PETER WENTLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
698 FEATHERSTONE RD, ROCKFORD, IL 61107
(815) 398-3277
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036092325
IL
207Q00000X
Family Medicine Physician
036092325
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036092325
—
IL
Enumeration date
07/13/2006
Last updated
05/31/2018
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