Provider Demographics
NPI:1871190546
Name:WIENKAMP, PHILIP MAXWELL
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:MAXWELL
Last Name:WIENKAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6194 OAKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-4444
Mailing Address - Country:US
Mailing Address - Phone:513-706-5999
Mailing Address - Fax:
Practice Address - Street 1:6194 OAKHAVEN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-4444
Practice Address - Country:US
Practice Address - Phone:513-706-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program