Provider Demographics
NPI:1962639633
Name:WILDE, BRENDEN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDEN
Middle Name:ROBERT
Last Name:WILDE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4300 MARKETPOINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5435
Mailing Address - Country:US
Mailing Address - Phone:952-835-9880
Mailing Address - Fax:952-857-1554
Practice Address - Street 1:4300 MARKETPOINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-835-9880
Practice Address - Fax:952-857-1554
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2018-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN54882207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine