Provider Demographics
NPI:1285638163
Name:WAYTZ, PAUL HARVEY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HARVEY
Last Name:WAYTZ
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 1:7600 FRANCE AVE S STE 5100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:952-893-1959
Mailing Address - Fax:952-893-1954
Practice Address - Street 1:7600 FRANCE AVE S STE 5100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-893-1959
Practice Address - Fax:952-893-1954
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21823207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3201962OtherMEDICA
FM100473C477OtherUCARE
MN960080401003OtherPREFERRED ONE
MNHP14653OtherHEALTHPARTNERS
FM660003174OtherRR MEDICARE
MN24898OtherAMERICA'S PPO
MN579000000Medicaid
MN66Q43WAOtherBLUE CROSS BLUE SHIELD
MN411774839A006OtherCHAMPUS