Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 28446 | MN |
NPI | 1093732984 |
---|---|
Provider Name | Dr. Michael Ross Wexler |
First Address | Minnetonka, MN 55305-1978 |
Second Address | Minnetonka, MN 55305-1978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A94328 | (02) |