Individual
MICHAEL WOOTTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1020 WEST BROADWAY, UMP-BROADWAY FAMILY MEDICINE, MINNEAPOLIS, MN 55411
(612) 302-8200
(612) 302-8275
Mailing address
720 WASHIGNTON AVE SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55414
(612) 884-0649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30205
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-12683
MEDICA - PRIMARY
MN
01
—
0190027
PREFERREDONE
MN
01
—
059550
FAIRVIEW
MN
01
—
109253
UCARE
MN
01
—
36A76WO
BLUE CROSS BLUE SHIELD
MN
01
—
768417
ARAZ
MN
01
—
HP27070
HEALTHPARTNERS
MN
Enumeration date
10/04/2006
Last updated
04/23/2012
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