Healthcare Provider Details

I. General information

NPI: 1235394784
Provider Name (Legal Business Name): TAMI RENEE WAHLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 FRANCE AVE S SUITE 417
EDINA MN
55435-4305
US

IV. Provider business mailing address

3131 CASCO CIR
WAYZATA MN
55391-9716
US

V. Phone/Fax

Practice location:
  • Phone: 952-922-7000
  • Fax:
Mailing address:
  • Phone: 612-819-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number32755
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: