Individual
DR. SCOTT EDWARD WAVINAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4151 WILLOWWOOD ST SE, PRIOR LAKE, MN 55372-4304
(952) 226-2600
Mailing address
4151 WILLOWWOOD ST SE, PRIOR LAKE, MN 55372-4304
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
60135
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2014
Last updated
09/17/2024
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