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General NPI Number Information
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NPI Number | 1235394784
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Entity Type | Individual
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Provider Name | TAMI RENEE WAHLIN MD
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Gender | Female
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 7250 FRANCE AVE S SUITE 417
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City | EDINA
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State | MN
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Zip | 55435-4305
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Country | US
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Telephone | 952-922-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 CASCO CIR
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City | WAYZATA
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State | MN
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Zip | 55391-9716
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Country | US
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Telephone | 612-819-1928
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 32755
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License Number State | MN
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