1942307376 NPI number — CHRISTINE H WENDT MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942307376 NPI number — CHRISTINE H WENDT MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WENDT

Provider First Name:

CHRISTINE

Provider Middle Name:

H

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1942307376

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Second Line Business Mailing Address:

420 DELAWARE ST SE MMC 292

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55455

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-624-5682

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

516 DELAWARE ST SE

Provider Second Line Business Practice Location Address:

PWB CLINIC 2A

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55455-0356

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-624-5682

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0200X , with the licence number:  32936 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 207RP1001X , with the licence number: 32936 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

• Identifier: 1010395 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 4829753 . This is a "MEDICA - CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 090985 . This is a "FAIRVIEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 48-00006 . This is a "MEDICA - PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0051595 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 101531 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 768406 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 9D241WE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP22246 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".