Provider Demographics
NPI:1104816768
Name:LINDQUIST, WESLEY LELAND (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:LELAND
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:CENTRACARE CLINIC
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:CENTRACARE CLINIC
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110906OtherUCARE
943773800OtherMEDICAL ASSISTANCE MA
110104488OtherRR MEDICARE
2114014OtherFIRST HEALTH PLAN
600879OtherARAZ GROUP AMERICAS PPO
6D073L1OtherBLUE CROSS BLUE SHIELD
0400500OtherMEDICA HEALTH PLANS
986016OtherPREFERRED ONE
HP22729OtherHEALTH PARTNERS
D80170Medicare UPIN
119001621Medicare ID - Type Unspecified