Provider Demographics
NPI:1962447656
Name:OFSTEDAL, WESLEY O (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:O
Last Name:OFSTEDAL
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:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-0506
Mailing Address - Country:US
Mailing Address - Phone:218-435-1212
Mailing Address - Fax:218-435-1302
Practice Address - Street 1:102 SATHER DR
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1531
Practice Address - Country:US
Practice Address - Phone:218-435-1212
Practice Address - Fax:218-435-1302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN24827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDA9071015606OtherPREFERRED ONE #
MNHP19582OtherHEALTHPARTNERS #
MN17792Medicaid
MN603478OtherAMERICA'S PPO/ARAZ#
MN2F664OFOtherMNBS #
MN0106086OtherMEDICA #
MN10731OtherSIOUX VALLEY #
MN6473OtherNDBS #
D48856OtherUPIN #
MNMN100033OtherLHS #
MN142313OtherUCARE #