Provider Demographics
NPI:1265665707
Name:WALLENTIN, CYNTHIA LYNN (MD)
Entity Type:Individual
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First Name:CYNTHIA
Middle Name:LYNN
Last Name:WALLENTIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:STE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:239 GARDEN CITY DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-8215
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2015-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD151462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology