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NPI Code Detail

MEDICARE: JON K. WOGENSEN MD

MEDICARE: JON K. WOGENSEN 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
1207ZP0101XAnatomic Pathology Physician17424MN

General Provider Information

NPI Number : 1508833955
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON K. WOGENSEN MD
Provider Business Mailing Address
First Line : 201 E NICOLLET BLVD
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-5714
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 E NICOLLET BLVD
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-5714
Country : US
Telephone Number : 952-892-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2006
Last Update Date : 05/15/2008

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