Provider Demographics
NPI:1689924631
Name:MEISNER, JUDITH MW (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MW
Last Name:MEISNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 WOODRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3938
Mailing Address - Country:US
Mailing Address - Phone:952-931-3961
Mailing Address - Fax:
Practice Address - Street 1:4647 WOODRIDGE RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3938
Practice Address - Country:US
Practice Address - Phone:952-931-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29433207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology