Provider Demographics
NPI:1497766471
Name:EDINA PLASTIC SURGERY, LTD.
Entity Type:Organization
Organization Name:EDINA PLASTIC SURGERY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-925-1765
Mailing Address - Street 1:6525 FRANCE AVE. S., SUITE 300
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-925-1765
Mailing Address - Fax:952-925-1579
Practice Address - Street 1:6525 FRANCE AVE. S., SUITE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-925-1765
Practice Address - Fax:952-925-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty