Provider Demographics
NPI:1164498564
Name:WOLPERT, SETH I (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:I
Last Name:WOLPERT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41104A
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:851-254-7980
Practice Address - Fax:651-254-7969
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN42294208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13060Medicare UPIN