Provider Demographics
NPI:1275561649
Name:WASEMILLER, PAUL S (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:WASEMILLER
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 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4106
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4106
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5530208600000X
MN30844208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05999WAOtherMNBS #
NDND200111OtherLHS #
ND10661OtherNDBS #
MN25168OtherNDBS #
ND142301OtherUCARE #
ND15721Medicaid
ND27989OtherSIOUX VALLEY #
ND2880OtherNDBS #
ND327787900Medicaid
NDDA9051027008OtherPREFERRED ONE #
ND676675OtherAMERICA'S PPO/ARAZ #
ND7764390Medicaid
ND1700498OtherMEDICA #
NDND200111OtherLHS #
ND2880Medicare UPIN
A51892Medicare UPIN
ND05999WAOtherMNBS #
ND27989OtherSIOUX VALLEY #
ND142301OtherUCARE #
ND14515Medicare ID - Type UnspecifiedND MEDICARE #