MEDICARE: DR. ROBIN WAYNE HENDRICKS M.D.

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	174400000X	Specialist	35685	MN

General Provider Information

NPI Number	:	1245235746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN WAYNE HENDRICKS M.D.

Provider Business Mailing Address
First Line	:	1000 E 1ST ST
Second Line	:	STE 400
City	:	DULUTH
State	:	MN
Zip	:	55805-2297
Country	:	US
Telephone Number	:	218-722-5513
Fax Number	:	218-722-6515

Provider Business Practice Location Address
First Line	:	1000 E 1ST ST
Second Line	:	STE 400
City	:	DULUTH
State	:	MN
Zip	:	55805-2297
Country	:	US
Telephone Number	:	218-722-5513
Fax Number	:	218-722-6515

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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