Provider Demographics
NPI:1710930110
Name:EHRENWALD, EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:EHRENWALD
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 1:407 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1950
Mailing Address - Country:US
Mailing Address - Phone:218-786-4897
Mailing Address - Fax:218-786-4980
Practice Address - Street 1:407 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1950
Practice Address - Country:US
Practice Address - Phone:218-786-4897
Practice Address - Fax:218-786-4980
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN483552085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00313965OtherRAILROAD MEDICARE MN
MN087686100Medicaid
MN1604022OtherMEDICA
IA1716951Medicaid
MNHP60559OtherHEALTHPARTNERS
MN2437705OtherAMERICA'S PPO
MN2437705OtherWEA TRUST
MN95G99EHOtherBLUE CROSS BLUE SHIELD
MN1046525OtherPREFERRED ONE
MN138133OtherUCARE
WI34838300Medicaid
MN2437705OtherAMERICA'S PPO
MN300003890Medicare PIN
MNHP60559OtherHEALTHPARTNERS
MN138133OtherUCARE
WI004356135Medicare PIN
WI34838300Medicaid