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NPI Code Detail

MEDICARE: ROGER H WEENIG M.D.

MEDICARE: ROGER H WEENIG 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
1207N00000XDermatology Physician42111MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134108772
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER H WEENIG M.D.
Provider Business Mailing Address
First Line : 7205 UNIVERSITY AVE NE
Second Line :
City : FRIDLEY
State : MN
Zip : 55432-3134
Country : US
Telephone Number : 763-571-4000
Fax Number : 763-571-4000
Provider Business Practice Location Address
First Line : 7205 UNIVERSITY AVE NE
Second Line :
City : FRIDLEY
State : MN
Zip : 55432-3134
Country : US
Telephone Number : 763-571-4000
Fax Number : 763-571-4000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 05/18/2011

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Directions to “ ROGER H WEENIG M.D.” Practice Location

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