Individual
WILLIAM M WIENCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1050 LARPENTEUR AVE W, SAINT PAUL, MN 55113-6556
(651) 487-2831
(651) 487-1705
Mailing address
2025 SLOAN PL, STE 35, SAINT PAUL, MN 55117-2007
(651) 772-1572
(651) 772-1889
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17420
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
397873700
—
MN
Enumeration date
08/02/2006
Last updated
10/14/2011
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