Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 28237 | MN |
NPI | 1033107404 |
---|---|
Provider Name | Michael Howard Wipf |
First Address | Saint Paul, MN 55114-1052 |
Second Address | Saint Paul, MN 55102-2564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A95119 | (02) | MN |