MEDICARE: CHRISTINE L WESELY 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	207Q00000X	Family Medicine Physician	44867	MN

General Provider Information

NPI Number	:	1427023001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE L WESELY M.D.

Provider Business Mailing Address
First Line	:	3033 EXCELSIOR BLVD STE 275
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-5149
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 EXCELSIOR BLVD
Second Line	:	#275
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4688
Country	:	US
Telephone Number	:	612-827-4751
Fax Number	:

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	03/20/2012

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