Individual
MARK WILDGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1526 30TH ST NW, BEMIDJI, MN 56601-4133
(218) 751-0887
Mailing address
1526 30TH ST NW, BEMIDJI, MN 56601-4133
(218) 751-0887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
27217
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031530800
—
MN
Enumeration date
06/28/2005
Last updated
07/08/2007
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