Healthcare Provider Details

I. General information

NPI: 1528063500
Provider Name (Legal Business Name): GITTE WENGLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 W 66TH ST STE 210
EDINA MN
55435-2526
US

IV. Provider business mailing address

3250 W 66TH ST STE 210
EDINA MN
55435-2526
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-7337
  • Fax: 952-927-8610
Mailing address:
  • Phone: 952-927-7337
  • Fax: 952-927-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44287
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: