Healthcare Provider Details

I. General information

NPI: 1528020138
Provider Name (Legal Business Name): ALAN S. WEINGARDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WOODWINDS DR SUITE 230
WOODBURY MN
55125-2523
US

IV. Provider business mailing address

2080 WOODWINDS DR SUITE 110
WOODBURY MN
55125-2523
US

V. Phone/Fax

Practice location:
  • Phone: 651-578-6949
  • Fax: 651-578-3074
Mailing address:
  • Phone: 651-738-6600
  • Fax: 651-738-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number29011
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: