MEDICARE: DR. CHRISTOPHER J WENNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MN46428	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80013050	OTHER	MN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225006232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER J WENNER MD

Provider Business Mailing Address
First Line	:	218 MAIN ST
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-2533
Country	:	US
Telephone Number	:	320-685-3020
Fax Number	:	320-685-4462

Provider Business Practice Location Address
First Line	:	218 MAIN ST
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-2533
Country	:	US
Telephone Number	:	320-685-3020
Fax Number	:	320-685-4462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	02/12/2015

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