Individual
DR. TODD MICHAEL WENCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3740 UTICA RIDGE RD, STE B, BETTENDORF, IA 52722-1624
(563) 344-7400
(563) 359-9395
Mailing address
3740 UTICA RIDGE RD, STE B, BETTENDORF, IA 52722-1624
(563) 344-7400
(563) 359-9395
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036107635
IL
207Q00000X
Family Medicine Physician
Primary
34193
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-107635
—
IL
01
—
036107635
LIC #
IL
01
—
087306
HEALTH ALLIANCE
—
05
—
1214049
—
IA
01
—
34193
LIC #
IA
01
—
35176
BCBS
IA
01
—
8122900
BCBS GROUP NUMBER
IL
01
—
P00109991
MEDICARE RAILROAD
—
Enumeration date
02/06/2006
Last updated
07/14/2016
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