NPIMap

Organization Active NPI

Wayzata Children'S Clinic P.a.

  • Pediatrics Physician
  • Minnetonka, MN
National Provider Identifier
1023081577
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WAYZATA CHILDREN'S CLINIC P.A.
Practice address
14001 Ridgedale Dr
#100
Minnetonka, MN 55305-1753
Phone
(952) 473-0211
Fax
(952) 473-7908
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Martha R. Engelbrekt, MD
Title
President
Phone
(952) 473-0211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

14001 Ridgedale Dr
#100
Minnetonka, MN 55305-1753

Mailing address

14001 Ridgedale Dr
#100
Minnetonka, MN 55305-1753
Phone (952) 473-0211

National Provider Directory

National Provider Directory

Locations

3000 Hundertmark Rd
Ste 13
Chaska, MN 55318

111 Hundertmark Rd
Ste 420
Chaska, MN 55318
Phone (952) 448-3847

3000 Hundertmark Rd
Chaska, MN 55318
Phone (952) 443-3191

916 Saint Peter Ave E
Ste 120
Delano, MN 55328
Phone (763) 230-2780

14001 Ridgedale Dr
Ste 109
Hopkins, MN 55305

9325 Upland Ln N
Ste 111
Maple Grove, MN 55369
Phone (763) 324-8000

1900 Centracare Cir
#1300
Saint Cloud, MN 56303
Phone (320) 654-3610

4695 Shoreline Dr
Ste A
Spring Park, MN 55384
Phone (952) 495-8910

250 Central Ave N
Ste 101
Wayzata, MN 55391
Phone (952) 473-0211

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1023081577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14001 RIDGEDALE DR",
            "address_2": "#100",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051753",
            "telephone_number": "952-473-0211",
            "fax_number": "952-473-7908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14001 RIDGEDALE DR",
            "address_2": "#100",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051753",
            "telephone_number": "952-473-0211",
            "fax_number": "952-473-7908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYZATA CHILDREN'S CLINIC P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "ENGELBREKT",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-473-0211",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.