Healthcare Provider Details

I. General information

NPI: 1225006232
Provider Name (Legal Business Name): CHRISTOPHER J WENNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MAIN ST
COLD SPRING MN
56320-2533
US

IV. Provider business mailing address

218 MAIN ST
COLD SPRING MN
56320-2533
US

V. Phone/Fax

Practice location:
  • Phone: 320-685-3020
  • Fax: 320-685-4462
Mailing address:
  • Phone: 320-685-3020
  • Fax: 320-685-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMN46428
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: