Provider Demographics
NPI:1891892261
Name:WEINERT, CRIAG R (MD)
Entity Type:Individual
Prefix:
First Name:CRIAG
Middle Name:R
Last Name:WEINERT
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 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:PWB SECOND FLOOR, CLINIC 2A
Practice Address - Street 2:516 DELAWARE STREET SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38371207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1975680Medicaid
MN4800020OtherMEDICA - CHOICE
MN768404OtherARAZ
MN883822400Medicaid
MN04T85WEOtherBLUE CROSS BLUE SHIELD
SD7777470Medicaid
MN106658OtherUCARE
WI32180300Medicaid
MN48-00006OtherMEDICA - PRIMARY
MNHP20573OtherHEALTHPARTNERS
MN1011042OtherPREFERREDONE
MN090811OtherFAIRVIEW
ND10387Medicaid
MN48-00006OtherMEDICA - PRIMARY