Provider Demographics
NPI:1144209743
Name:WIEDENHOEFER, JAMES FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FREDERICK
Last Name:WIEDENHOEFER
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 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:
Practice Address - Street 1:11995 SINGLETREE LN STE 500
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5349
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP46242085R0202X
PAMD4617482085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX438638YSHEMedicare PIN
TXP01547679OtherRAILROAD MEDICARE
TXP4624OtherTEXAS MEDICAL LICENSE
TXP01547681OtherRAILROAD MEDICARE
TX438638YSHDMedicare PIN
TX3501454-01Medicaid
TX3501454-02Medicaid
TX3501454-03Medicaid