Wildgen, Mark

Wildgen, Mark is an individual health care provider with primary practice located at 1526 30Th St Nw , Bemidji MN 56601-4133. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Wildgen, Mark can be contacted via phone (218) 751-0887.

Contact Information

Primary practice address
1526 30Th St Nw Bemidji MN 56601-4133
Phone: (218) 751-0887
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 27217 Minnesota

Profile Details

NPI number 1902803539
LBN Legal business name Wildgen, Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902803539 NPPES
Minnesota MEDICAID 031530800

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