Provider Demographics
NPI:1386969327
Name:WACKER, DAVID ANTHONY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:WACKER
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Gender:M
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 276
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-624-0999
Mailing Address - Fax:612-625-2174
Practice Address - Street 1:401 E RIVER PKWY
Practice Address - Street 2:SUITE 350, VCRC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0368
Practice Address - Country:US
Practice Address - Phone:612-624-0999
Practice Address - Fax:612-625-2174
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2019-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN60619207P00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine