MEDICARE: MICHAEL HOWARD WIPF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	28237	MN

General Provider Information

NPI Number	:	1033107404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HOWARD WIPF M.D.

Provider Business Mailing Address
First Line	:	2550 UNIVERSITY AVE W
Second Line	:	SUITE 240N
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1052
Country	:	US
Telephone Number	:	651-999-6909
Fax Number	:	651-297-6115

Provider Business Practice Location Address
First Line	:	360 SHERMAN ST
Second Line	:	SUITE 400
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2564
Country	:	US
Telephone Number	:	651-999-6800
Fax Number	:	651-999-6910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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