Individual
MARK J WANDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2535 UNIVERSITY AVE SE, MINNEAPOLIS, MN 55414-3205
(612) 672-2350
(651) 642-9441
Mailing address
2535 UNIVERSITY AVE SE, MINNEAPOLIS, MN 55414-3205
(612) 672-2350
(651) 642-9441
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
30314
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
454372600
—
MN
Enumeration date
06/24/2006
Last updated
04/11/2012
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