Provider Demographics
NPI:1548249741
Name:WENDSCHUH, PHILIP DIEDRICH (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DIEDRICH
Last Name:WENDSCHUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD STE 127
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-414-9200
Mailing Address - Fax:216-201-5582
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 127
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1654
Practice Address - Country:US
Practice Address - Phone:440-414-9200
Practice Address - Fax:216-201-5582
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053910207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060020030OtherRAILROAD MEDICARE
OH000000128712OtherANTHEM
OH341221800076OtherCARESOURCE
OH100401OtherKAISER
OHE29046OtherSUMMACARE
OH0866817Medicaid
OH4011475Medicare PIN
OH000000128712OtherANTHEM
060020030OtherRAILROAD MEDICARE
OH9288884Medicare PIN