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NPI Code Detail

MEDICARE: PAUL WRATKOWSKI DO

MEDICARE: PAUL WRATKOWSKI DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician57942MN
3208000000XPediatrics Physician57942MN

General Provider Information

NPI Number : 1083909733
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL WRATKOWSKI DO
Provider Business Mailing Address
First Line : 2450 RIVERSIDE AVE
Second Line : PEDIATRIC EDUCATION OFFICE M136 8950A
City : MINNEAPOLIS
State : MN
Zip : 55454-1450
Country : US
Telephone Number : 612-624-4477
Fax Number :
Provider Business Practice Location Address
First Line : 2450 RIVERSIDE AVE
Second Line : PEDIATRIC EDUCATION OFFICE M136 8950A
City : MINNEAPOLIS
State : MN
Zip : 55454-1450
Country : US
Telephone Number : 612-624-4477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2011
Last Update Date : 06/25/2026

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