MEDICARE: MR. RICHARD S WERNER 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	2086S0122X	Plastic and Reconstructive Surgery Physician	25128	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1578569539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD S WERNER MD

Provider Business Mailing Address
First Line	:	7801 EAST BUSH LAKE RD
Second Line	:	SUITE 320
City	:	BLOOMINGTON
State	:	MN
Zip	:	55439
Country	:	US
Telephone Number	:	952-831-5773
Fax Number	:	952-831-7224

Provider Business Practice Location Address
First Line	:	6545 FRANCE AVE. S
Second Line	:	SUITE 276
City	:	EDINA
State	:	MN
Zip	:	55435
Country	:	US
Telephone Number	:	952-929-1812
Fax Number	:	952-929-1943

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/14/2009

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