Individual
RONALD BRUCE WAHLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1313 PENN AVENUE NORTH, MINNEAPOLIS, MN 55411
(612) 543-2558
(612) 302-4870
Mailing address
1313 PENN AVENUE NORTH, MINNEAPOLIS, MN 55411
(612) 543-2558
(612) 302-4870
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29429
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
788785000
—
MN
Enumeration date
04/19/2006
Last updated
02/21/2013
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