Provider Demographics
NPI:1225354947
Name:WAIBEL, NATHAN GEORGE BUTLER (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:GEORGE BUTLER
Last Name:WAIBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:GEORGE
Other - Last Name:WAIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7701 YORK AVE S
Mailing Address - Street 2:STE 300
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5864
Mailing Address - Country:US
Mailing Address - Phone:952-915-5261
Mailing Address - Fax:952-926-6501
Practice Address - Street 1:7701 YORK AVE S STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5864
Practice Address - Country:US
Practice Address - Phone:952-926-6489
Practice Address - Fax:952-926-6501
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54310207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine