MEDICARE: JOEL WEGENER MD

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	207Q00000X	Family Medicine Physician	45155	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1725613	OTHER	MN	ARAZ
2	01-18359	OTHER	MN	MEDICA - CHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01-18359	OTHER	MN	MEDICA - PRIMARY
5	1032282	OTHER	MN	PREFERREDONE
6	548R7WE	OTHER	MN	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	132038	OTHER	MN	UCARE
9	HP40859	OTHER	MN	HEALTHPARTNERS

General Provider Information

NPI Number	:	1063519437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL WEGENER MD

Provider Business Mailing Address
First Line	:	420 DELAWARE STREET SE, MMC 292
Second Line	:	UNIVERSITY OF MINNESOTA PHYSICIANS
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455
Country	:	US
Telephone Number	:	612-333-0475
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 EAST FRANKLIN AVENUE
Second Line	:	UFP-SMILEY'S CLINIC
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406
Country	:	US
Telephone Number	:	612-333-0770
Fax Number	:	612-333-0475

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/11/2012

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Directions to “ JOEL WEGENER MD” Practice Location

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