| Wensley M Keith MD PC | |
|
1601 Dove St Ste 170 Newport Beach CA 92660-1421 | |
| (949) 610-5240 | |
| Not Available |
| Full Name | Wensley M Keith MD PC |
|---|---|
| Speciality | General Practice |
| Location | 1601 Dove St Ste 170, Newport Beach, California |
| Authorized Official Name and Position | Tammy Knickerbocker (MANAGER) |
| Authorized Official Contact | 9496105240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wensley M Keith MD PC 1601 Dove St Ste 170 Newport Beach CA 92660-1421 Ph: (949) 610-5240 | Wensley M Keith MD PC 1601 Dove St Ste 170 Newport Beach CA 92660-1421 Ph: (949) 610-5240 |
| NPI Number | 1174357768 |
|---|---|
| Provider Enumeration Date | 08/27/2024 |
| Last Update Date | 05/28/2025 |
| Certification Date | 05/28/2025 |
| Medicare PECOS PAC ID | 7113428319 |
|---|---|
| Medicare Enrollment ID | O20250828005317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174357768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
| Provider Name | Michael K Wensley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841336740 PECOS PAC ID: 9739238692 Enrollment ID: I20090522000456 |
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