Provider Demographics
NPI:1568595783
Name:WAHMAN, STEPHEN BRYAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRYAN
Last Name:WAHMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 VILLAGE CENTER DR
Mailing Address - Street 2:#329
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3016
Mailing Address - Country:US
Mailing Address - Phone:651-341-3630
Mailing Address - Fax:
Practice Address - Street 1:1575 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8517
Practice Address - Country:US
Practice Address - Phone:651-341-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN370213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN846471Medicaid
MN27-11884OtherMEDICA PROVIDER NO.
MN18033OtherHEALTH PARTNERS
MN104402OtherU CARE MINNESOTA
MN27-11884OtherMEDICA PROVIDER NO.