Provider Demographics
NPI:1063519437
Name:WEGENER, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:WEGENER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE STREET SE, MMC 292
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-333-0475
Mailing Address - Fax:
Practice Address - Street 1:2615 EAST FRANKLIN AVENUE
Practice Address - Street 2:UFP-SMILEY'S CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:612-333-0475
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-04-11
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Provider Licenses
StateLicense IDTaxonomies
MN45155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1725613OtherARAZ
MN01-18359OtherMEDICA - CHOICE
IA0595637Medicaid
MN01-18359OtherMEDICA - PRIMARY
MN1032282OtherPREFERREDONE
MN548R7WEOtherBCBS
MN443917100Medicaid
MN132038OtherUCARE
MNHP40859OtherHEALTHPARTNERS
MN132038OtherUCARE
IA0595637Medicaid