Individual
GLENN W WEIDENBACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16830 198TH AVE NW, BIG LAKE CLINIC, BIG LAKE, MN 55309
(763) 263-7300
(763) 263-7334
Mailing address
16830 198TH AVE NW, BIG LAKE CLINIC, BIG LAKE, MN 55309
(763) 263-7300
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
48083
MN
Other
Enumeration date
12/22/2005
Last updated
03/10/2008
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