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NPI Code Detail

MEDICARE: CHRISTOPHER ALAN WALL M.D.

MEDICARE: CHRISTOPHER ALAN WALL 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
12084P0800XPsychiatry Physician43819MN

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 : 1831160217
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER ALAN WALL M.D.
Provider Business Mailing Address
First Line : 9400 ZANE AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1814
Country : US
Telephone Number : 763-762-8800
Fax Number :
Provider Business Practice Location Address
First Line : 5255 MEMBERS PKWY NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-8381
Country : US
Telephone Number : 507-218-3701
Fax Number : 507-258-5503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 09/14/2020

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