Provider Demographics
NPI:1104099381
Name:WUDEL, JUSTIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:WUDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7300 FRANCE AVE S
Mailing Address - Street 2:SUITE 410
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4544
Mailing Address - Country:US
Mailing Address - Phone:952-227-3639
Mailing Address - Fax:952-548-5254
Practice Address - Street 1:7300 FRANCE AVE S
Practice Address - Street 2:SUITE 410
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4544
Practice Address - Country:US
Practice Address - Phone:952-227-3639
Practice Address - Fax:952-548-5254
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2016-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
MN58271207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Yes174400000XOther Service ProvidersSpecialist