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General NPI Number Information
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NPI Number | 1528421062
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Entity Type | Individual
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Provider Name | ELIZABETH PARK WAHL MD
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Gender | Female
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 8100 W 78TH ST STE 230
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City | EDINA
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State | MN
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Zip | 55439-2570
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Country | US
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Telephone | 952-946-9777
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Fax | 952-946-9888
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Provider Business Mailing Address
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Address Line | PO BOX 43
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City | MINNEAPOLIS
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State | MN
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Zip | 55440-0043
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Country | US
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Telephone | 612-262-1166
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Fax | 612-262-4258
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD61270493
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | MD61270493
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 76582
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License Number State | MN
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