John Geoffrey Wahlstrom, M.D.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

28022 Issued in MN

Practice address

565 Snelling Ave S
Saint Paul, MN 55116-1525

Phone

(651) 698-0386

Fax

(651) 698-0483

NPI assigned

Jul 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358899200000",
    "number": "1104823335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 SNELLING AVE S",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161525",
            "telephone_number": "651-698-0386",
            "fax_number": "651-698-0483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 SNELLING AVE S",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161525",
            "telephone_number": "651-698-0386",
            "fax_number": "651-698-0483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLSTROM",
        "first_name": "JOHN",
        "middle_name": "GEOFFREY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2013-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MN",
            "license": "28022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josh T Wahl, CRNA
• Lisa A Wahl, CRNA
• Joseph C Wahlberg, MD
• Mary Claire Wahlberg, LICSW
• Madison Wahlen
• Kyle L Wahlstrom, MD
• Ebtisam Wais
• Hawo Wako
• Mubark Hussen Wako
• Wal-Mart Stores, Inc.

• Allergy & Immunology Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Allergy & Immunology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.