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General NPI Number Information
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NPI Number | 1225354947
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Entity Type | Individual
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Provider Name | NATHAN GEORGE BUTLER WAIBEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 7701 YORK AVE S STE 300
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City | EDINA
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State | MN
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Zip | 55435-5864
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Country | US
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Telephone | 952-926-6489
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Fax | 952-926-6501
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Provider Business Mailing Address
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Address Line | 7701 YORK AVE S STE 300
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City | EDINA
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State | MN
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Zip | 55435-5864
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Country | US
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Telephone | 952-915-5261
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Fax | 952-926-6501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 54310
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 54310
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License Number State | MN
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