MEDICARE: WOODLAND UROLOGY, PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	163D1WO	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1760497556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND UROLOGY, PA

Provider Business Mailing Address
First Line	:	3920 13TH AVE E
Second Line	:	SUITE 6
City	:	HIBBING
State	:	MN
Zip	:	55746-3675
Country	:	US
Telephone Number	:	218-263-7540
Fax Number	:	866-732-0699

Provider Business Practice Location Address
First Line	:	901 9TH ST N
Second Line	:	SUITE 315
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2325
Country	:	US
Telephone Number	:	218-742-8640
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAMUEL KRIEGLER
Credential	:
Telephone Number	:	218-742-8640

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/18/2008

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Directions to “WOODLAND UROLOGY, PA ” Practice Location

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