Healthcare Provider Details

I. General information

NPI: 1548390255
Provider Name (Legal Business Name): ROBYN FRIEDMAN WETTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN ANN FRIEDMAN M.D.

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

1120 WAYZATA BLVD E SUITE 100
WAYZATA MN
55391-1916
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3987
  • Fax: 952-993-3663
Mailing address:
  • Phone: 952-476-6733
  • Fax: 952-476-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number51825
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number51825
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: