Provider Demographics
NPI:1285720904
Name:WILSON, ROBERT F (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE MMC292
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-3600
Mailing Address - Fax:
Practice Address - Street 1:PWB THIRD FLOOR, CLINIC 3B
Practice Address - Street 2:516 DELAWARE STREET SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30226207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP22052OtherHEALTHPARTNERS
MN25-00021OtherMEDICA - PRIMARY
MN1009356OtherPREFERREDONE
MN2T193WIOtherBLUE CROSS BLUE SHIELD
MN378282400Medicaid
MN032912OtherFAIRVIEW
MN100766OtherUCARE
MN777980OtherARAZ
MN2522592OtherMEDICA - CHOICE
MN060015215Medicare ID - Type UnspecifiedRAILROAD
MN378282400Medicaid